Provider Demographics
NPI:1013355973
Name:IYENGAR, HARI (MD)
Entity Type:Individual
Prefix:DR
First Name:HARI
Middle Name:
Last Name:IYENGAR
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:PO BOX 19670
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9670
Mailing Address - Country:US
Mailing Address - Phone:217-757-8100
Mailing Address - Fax:217-757-8161
Practice Address - Street 1:520 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5238
Practice Address - Country:US
Practice Address - Phone:217-757-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37469207Q00000X
ARE-13528207Q00000X
IN01084463A207Q00000X
LA310369207Q00000X
MI4301502824207Q00000X
MS26170207Q00000X
NY303086-01207Q00000X
NC2020-03214207Q00000X
OH35.140368207Q00000X
PAMD471358207Q00000X
TN60271207Q00000X
TXS5189207Q00000X
MO2020041318207Q00000X
OK36935207Q00000X
IL125063654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine