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General NPI Number Information
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NPI Number | 1689638033
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Entity Type | Individual
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Provider Name | TAREK KUDAIMI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 801 MACARTHUR BLVD SUITE 305
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City | MUNSTER
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State | IN
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Zip | 46321-2915
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Country | US
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Telephone | 219-836-1310
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Fax | 219-836-0617
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Provider Business Mailing Address
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Address Line | 801 MACARTHUR BLVD SUITE 305
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City | MUNSTER
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State | IN
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Zip | 46321-2915
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Country | US
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Telephone | 219-836-1310
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Fax | 219-836-0617
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 01044239
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01044239
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License Number State | IN
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