Basic Information
| Provider Information | |||||||||
| NPI: | 1659649010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOURADDIN | ||||||||
| FirstName: | NOURADDIN | ||||||||
| MiddleName: | NASHAT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 N EDDY ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466172808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742379340 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 211 N EDDY ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466172808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742379340 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2011 | ||||||||
| LastUpdateDate: | 07/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD446577 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01072144A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.