Provider Demographics
NPI:1194782698
Name:HAJJ, MAKRAM Y (MD)
Entity type:Individual
Prefix:
First Name:MAKRAM
Middle Name:Y
Last Name:HAJJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:STE 265
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3015
Practice Address - Country:US
Practice Address - Phone:317-688-5100
Practice Address - Fax:317-688-5111
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048464A207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000630032OtherANTHEM
IN200191960Medicaid
INP01002397OtherRAILROAD MEDICARE PTAN
E48486Medicare UPIN
INP00632881Medicare PIN
IN247020NMedicare PIN
IN200191960Medicaid
INM400038677Medicare PIN
IN218650MMedicare PIN
INP01002397OtherRAILROAD MEDICARE PTAN
IN183380NNNNMedicare PIN