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General NPI Number Information
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NPI Number | 1518164284
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Entity Type | Individual
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Provider Name | NADIM HAFEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 9660 WICKER AVE
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City | SAINT JOHN
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State | IN
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Zip | 46373-9487
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Country | US
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Telephone | 219-365-1177
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Fax | 219-703-6662
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Provider Business Mailing Address
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Address Line | 8558 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-7032
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Country | US
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Telephone | 219-392-7084
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Fax | 219-703-6854
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036128550
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01072325A
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License Number State | IN
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