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General NPI Number Information
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NPI Number | 1912237017
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Entity Type | Organization
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Legal Business Name | TAREK KUDAIMI MD, LLC
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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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 | OWNER MANAGER
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Name | DR. TAREK KUDAIMI
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Credential | MD
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Telephone | 219-836-1310
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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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