| Advanced Internal Medicine Of Michiana | |
|
3809 N Main St Ste 100 Mishawaka IN 46545-3109 | |
| (574) 520-1700 | |
| (833) 989-0916 |
| Full Name | Advanced Internal Medicine Of Michiana |
|---|---|
| Speciality | Clinic/Center |
| Location | 3809 N Main St Ste 100, Mishawaka, Indiana |
| Authorized Official Name and Position | Dahan Al-fadhl (C.E.O.) |
| Authorized Official Contact | 5742749523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Internal Medicine Of Michiana 52103 Brendon Hills Dr Granger IN 46530-7811 Ph: (574) 274-9523 | Advanced Internal Medicine Of Michiana 3809 N Main St Ste 100 Mishawaka IN 46545-3109 Ph: (574) 520-1700 |
| NPI Number | 1194288860 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 04/03/2024 |
| Medicare PECOS PAC ID | 4981938164 |
|---|---|
| Medicare Enrollment ID | O20190621000152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194288860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Dahan H Al Fadhl |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740235183 PECOS PAC ID: 8022186170 Enrollment ID: I20081002000648 |
| Provider Name | Motasem Afyouni |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306011606 PECOS PAC ID: 6103994322 Enrollment ID: I20081007000733 |
| Provider Name | Carole Anne Derucki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205809225 PECOS PAC ID: 4789609215 Enrollment ID: I20081010000222 |
| Provider Name | Ramesh C Aggarwal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649458712 PECOS PAC ID: 9335214709 Enrollment ID: I20121011000794 |
| Provider Name | Jacob Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891957981 PECOS PAC ID: 8628240975 Enrollment ID: I20121017000483 |
| Provider Name | Jude Poku |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205215415 PECOS PAC ID: 1850723487 Enrollment ID: I20230206001553 |
| Provider Name | Janet Ultreras |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093410375 PECOS PAC ID: 6800256660 Enrollment ID: I20230712003092 |
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