Provider Demographics
NPI:1467685677
Name:HARB, JAD (MD)
Entity Type:Individual
Prefix:
First Name:JAD
Middle Name:
Last Name:HARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAD
Other - Middle Name:
Other - Last Name:HARB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210B MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3435
Practice Address - Country:US
Practice Address - Phone:765-298-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074773A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201300070Medicaid
INP01824450OtherRR PTAN
IN201300070Medicaid
IN218380002Medicare PIN