Provider Demographics
NPI:1528058039
Name:SAMI, TARIQ KAMAL (MD)
Entity type:Individual
Prefix:
First Name:TARIQ
Middle Name:KAMAL
Last Name:SAMI
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 1:1025 RIVER OAK RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-3541
Mailing Address - Country:US
Mailing Address - Phone:260-436-2756
Mailing Address - Fax:
Practice Address - Street 1:VA NORTHERN INDIANA HEALTH CARE SYSTEM,
Practice Address - Street 2:2121 LAKE AVENUE
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050365A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine