Healthcare Provider Details

I. General information

NPI: 1073503207
Provider Name (Legal Business Name): IMAD GEORGE KOJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 S 7TH ST STE 2E
TERRE HAUTE IN
47802-5710
US

IV. Provider business mailing address

3903 S 7TH ST STE 2E
TERRE HAUTE IN
47802-5710
US

V. Phone/Fax

Practice location:
  • Phone: 812-235-7370
  • Fax: 812-235-7570
Mailing address:
  • Phone: 812-235-7370
  • Fax: 812-235-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01048808A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: