Provider Demographics
NPI:1396944120
Name:INTERNAL MEDICINE OF WATERLOO
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF WATERLOO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:TOUFIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHAAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-233-3044
Mailing Address - Street 1:PO BOX 2818
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3741 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5215
Practice Address - Country:US
Practice Address - Phone:319-233-3044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI12588Medicare PIN