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General NPI Number Information
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NPI Number | 1396787479
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Entity Type | Individual
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Provider Name | MOHAMAD HYTHAM RIFAI MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 200 E 89TH AVE SUITE 3A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7318
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Country | US
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Telephone | 219-756-2900
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Fax | 219-756-2910
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Provider Business Mailing Address
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Address Line | 200 E 89TH AVE SUITE 3A
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7318
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Country | US
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Telephone | 219-756-2900
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Fax | 219-756-2910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 01035906
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License Number State | IN
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