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NPI Code Detail

MEDICARE: IMAD E HORANI M.D.

MEDICARE: IMAD E HORANI M.D.
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
1207RG0100XGastroenterology Physician01034917IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00785645OTHERINMEDICARE RR
6100006559OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000638370OTHERINANTHEM
34047092OTHERINAETNA PROVIDER NUMBER
42765686001OTHERINCIGNA PROVIDER NUMBER
50000000084166OTHERINBCBS PROVIDER NUMBER
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902895949
Entity Type Code : Individual
Provider Name (Legal Business Name) : IMAD E HORANI M.D.
Provider Business Mailing Address
First Line : 1234 E DUPONT RD
Second Line : SUITE 3
City : FORT WAYNE
State : IN
Zip : 46825-1545
Country : US
Telephone Number : 260-373-7875
Fax Number : 260-373-9705
Provider Business Practice Location Address
First Line : 2231 CAREW ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-4713
Country : US
Telephone Number : 260-266-5230
Fax Number : 260-373-9393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 09/23/2013

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Directions to “ IMAD E HORANI M.D.” Practice Location

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