DR. IMAD E. KHADRA (NPI# 1205855418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205855418 |
| Entity Type | Individual |
| Full Name | DR. IMAD E. KHADRA |
| Credential | MD |
| Practice Address |
3920 St Francis Way Ste 220 Lafayette IN 47905 |
| Mailing Address |
Po Box 781076 Detroit MI 48278-1076 |
| Practice Telephone | 7655024110 |
| Practice Fax Number | 7654285951 |
| Mailing Telephone | 3175284800 |
| Mailing Fax Number | 3178651479 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-04-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
01036728 | IN | Allopathic & Osteopathic Physicians |
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
01036728 | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100087520 | 05 | |
| IN | MEDICARE PTAN | M400062471 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2708 Ferry St, Lafayette, IN 479043021 | 7654461571 | 7654473068 |
| Street Address |
3920 ST FRANCIS WAY STE 220 |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043280670 | Salim S Abou Jaoude | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2006-01-25 |
| 1275912602 | Samuel Levi Worsham | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2015-05-18 |
| 1750677589 | Pradeep Gnanapragasam | Physical Medicine & Rehabilitation | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2011-06-20 |
| 1437200557 | Nini C Thomas | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905 | 2007-01-16 |
| 1841387529 | Andrew J Krutul | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905 | 2006-10-06 |
| 1881617538 | Jill M. Reisman | Physician Assistant | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2006-07-25 |
| 1477575769 | Mark D. Griffith | Physical Medicine & Rehabilitation | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2006-07-24 |
| 1982623120 | Rita A. Mankus | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905 | 2006-07-19 |
| 1740208180 | Shahid Ahsan | Internal Medicine | 3920 St Francis Way Ste 220, Lafayette, IN 47905-4922 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719893 | Elements Counseling LLC | Social Worker | 115 N. Farabee Drive, Lafayette, IN 47905 | 2019-09-18 |
| 1134596869 | Indiana Dental Sleep Therapy LLC | Dentist | 4921 Sr 26 E, Suite 300, Lafayette, IN 47905 | 2015-08-28 |
| 1255750899 | Emily S Miller | Physical Therapist | 1701 Creasy Ln, Lafayette, IN 47905 | 2014-04-10 |
| 1073876215 | Nathan Webster | Dentist | 1530 Kossuth St., Lafayette, IN 47905 | 2012-06-22 |
| 1578848370 | Mark Jin Kim | Pharmacist | 1801 South St., Lafayette, IN 47905 | 2011-10-13 |
| 1700177185 | Shannon Tawn Harris | Speech-Language Pathologist | 8900 Cobbler Lane, Lafayette, IN 47905 | 2011-04-20 |
| 1508164484 | David Thomas Beine | Specialist/Technologist | 1321 Unity Pl Ste A, Lafayette, IN 47905 | 2011-03-02 |
| 1447569538 | Deidre Dudley | Nurse Practitioner | 1701 S Creasy Ln Ste 1w93, Lafayette, IN 47905 | 2010-10-07 |
| 1548493067 | Unity Healthcare, LLC | Podiatrist | 750 Park East Blvd, Unit 4, Lafayette, IN 47905 | 2009-09-01 |
| 1073762969 | Lynette Marie Alexander | Nurse Practitioner | 5500 St Rd. 38 East, Lafayette, IN 47905 | 2008-09-16 |
| Find all providers in zip 47905 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770872616 | Gbr, LLC | Internal Medicine | 155 Hospital Dr. Ste 101, Lafayette, LA 70503 | 2011-03-31 |
| 1568492536 | Philip S. Perret, M.d., Apmc | Internal Medicine | 614 W Saint Mary Blvd, Lafayette, LA 70506-3538 | 2006-07-04 |
| 1285617803 | Mazen Alakhras | Internal Medicine | 2708 Ferry St, Lafayette, IN 47904 | 2005-11-29 |
| 1265428585 | Richard Hsin Fei | Internal Medicine | 4811 Ambassador Caffery Pkwy, Suite 305, Lafayette, LA 70508-7265 | 2005-09-22 |
| 1699761056 | Fadi Yosef Malek | Internal Medicine | 227 Bendel Rd, Lafayette, LA 70503-2903 | 2005-09-21 |
| 1841286200 | Bendel Medical Associates, LLC | Internal Medicine | 227a Bendel Rd, Lafayette, LA 70503-2903 | 2005-09-21 |
| 1093915894 | Philip S Perret | Internal Medicine | 614 W Saint Mary Blvd, Lafayette, LA 70506-3538 | 2007-07-19 |
| 1356478309 | William V Kinnard | Internal Medicine | 280 Exempla Cir, Lafayette, CO 80026-3370 | 2007-02-27 |
| 1477697266 | Patricia Sato | Internal Medicine | 280 Exempla Cir, Lafayette, CO 80026-3370 | 2007-02-16 |
| 1518035104 | Ewing Cook | Internal Medicine | 5000 Ambassador Caffery, Province Bldg. 14-a, Lafayette, LA 70508 | 2006-12-01 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.