Provider Demographics
NPI:1063417657
Name:ABDULLAH, RAIED (MD)
Entity type:Individual
Prefix:
First Name:RAIED
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-931-5227
Mailing Address - Fax:219-932-8455
Practice Address - Street 1:3229 BROADWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46409-1036
Practice Address - Country:US
Practice Address - Phone:219-887-4950
Practice Address - Fax:219-887-4955
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01052588A207RN0300X
IN01052558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200264560Medicaid
G54273Medicare UPIN
IN703060LMedicare PIN
IN200264560Medicaid
IN164210CMedicare UPIN