Provider Demographics
NPI:1720024615
Name:DALAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DALAL MEDICAL CORPORATION
Other - Org Name:DIGESTIVE DISEASE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-682-0464
Mailing Address - Street 1:9731 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3616
Mailing Address - Country:US
Mailing Address - Phone:219-922-4900
Mailing Address - Fax:219-836-9922
Practice Address - Street 1:9731 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3616
Practice Address - Country:US
Practice Address - Phone:219-922-4900
Practice Address - Fax:219-836-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207RG0100X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200007800Medicaid
IL91108144OtherBCBS OF IL
IN705400Medicare PIN