Provider Demographics
NPI:1629011747
Name:KUDAIMI, MUHAMMAD M (MD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:M
Last Name:KUDAIMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:12750 SAINT FRANCIS DR STE 410
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-0264
Practice Address - Country:US
Practice Address - Phone:219-769-8340
Practice Address - Fax:219-769-8341
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036331A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000095538OtherANTHEM
IL036062243OtherMEDICAID IL
IN100215010AMedicaid
7285621004OtherCIGNA
IL90000937OtherBLUE CROSS BLUE SHIELD
IN010021034OtherMEDICARE RAILROAD
IN100215010AMedicaid
IL036062243OtherMEDICAID IL