Provider Demographics
NPI:1821022146
Name:DALAL, SHREYASI H (MD)
Entity Type:Individual
Prefix:DR
First Name:SHREYASI
Middle Name:H
Last Name:DALAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 JOLIET ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1765
Mailing Address - Country:US
Mailing Address - Phone:219-227-3621
Mailing Address - Fax:219-865-5401
Practice Address - Street 1:11456 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7106
Practice Address - Country:US
Practice Address - Phone:219-227-3621
Practice Address - Fax:219-865-5401
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029779A207L00000X
IL036-061859207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC43289Medicare UPIN
IN141980MMedicare ID - Type Unspecified