Provider Demographics
NPI:1194784603
Name:KEDO, ABDULRAZAK (MD)
Entity type:Individual
Prefix:
First Name:ABDULRAZAK
Middle Name:
Last Name:KEDO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-1198
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:1339 N CHERRY STREET
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-1116
Practice Address - Country:US
Practice Address - Phone:765-932-7000
Practice Address - Fax:765-932-7001
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052945A208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01052945OtherLICENSE
IN000000373848OtherANTHEM
IN200319580Medicaid
IN941000DDDDMedicare PIN
IN000000373848OtherANTHEM