Provider Demographics
NPI:1407825722
Name:DALI, SAMMI M (MD)
Entity Type:Individual
Prefix:
First Name:SAMMI
Middle Name:M
Last Name:DALI
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 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-4004
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:3777 N FRONTAGE RD STE 900
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7698
Practice Address - Country:US
Practice Address - Phone:219-879-6021
Practice Address - Fax:219-879-6365
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057434A207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200439020Medicaid
P00605405OtherMEDICARE RR
IN000000560154OtherANTHEM
IN11202879OtherCAQH NUMBER
IN5710110004Medicare NSC
IN200439020Medicaid
IN200439020Medicaid