MEDICARE: KARIM MOSHREF MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	01042546	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265863187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARIM MOSHREF MD PC

Provider Business Mailing Address
First Line	:	2110 LOWER HUNTINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1235
Country	:	US
Telephone Number	:	260-478-9960
Fax Number	:	260-478-9670

Provider Business Practice Location Address
First Line	:	2110 LOWER HUNTINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1235
Country	:	US
Telephone Number	:	260-478-9960
Fax Number	:	260-478-9670

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. MIR ABDUL KARIM MOSHREF
Credential	:	M.D.
Telephone Number	:	260-478-9960

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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