Provider Demographics
NPI:1083614416
Name:HALLAL, ELI R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:R
Last Name:HALLAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4934
Mailing Address - Country:US
Mailing Address - Phone:812-948-1641
Mailing Address - Fax:812-941-0438
Practice Address - Street 1:1964 STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4934
Practice Address - Country:US
Practice Address - Phone:812-948-1641
Practice Address - Fax:812-941-0438
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025361A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115500AMedicaid
IN000000042312OtherANTHEM
IN351359575OtherCOMMERCIAL
INI001704OtherTRICARE /CHAMPUS
OH35135957500OtherOHIO BUREAU OF WORKERS' C
INI001704OtherTRICARE /CHAMPUS
IN351359575OtherCOMMERCIAL
INC24729Medicare UPIN