Provider Demographics
NPI:1861552986
Name:MEDICAL CLINICS OF AMERICA, P.C.
Entity type:Organization
Organization Name:MEDICAL CLINICS OF AMERICA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIRAJUDDIN
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-8600
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-1219
Mailing Address - Country:US
Mailing Address - Phone:219-836-8600
Mailing Address - Fax:
Practice Address - Street 1:7550 HOHMAN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1060
Practice Address - Country:US
Practice Address - Phone:219-836-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN199760Medicare ID - Type Unspecified
IL204374Medicare ID - Type Unspecified