Provider Demographics
NPI:1205811882
Name:CHHATIAWALA, HARIN J (MD)
Entity type:Individual
Prefix:
First Name:HARIN
Middle Name:J
Last Name:CHHATIAWALA
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 1:11600 GLADIOLUS DR STE C17
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4567
Mailing Address - Country:US
Mailing Address - Phone:239-790-2488
Mailing Address - Fax:239-790-2490
Practice Address - Street 1:11600 GLADIOLUS DR STE C17
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4567
Practice Address - Country:US
Practice Address - Phone:239-790-2488
Practice Address - Fax:239-790-2490
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041873A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2154510Medicaid
IN3937240010OtherMEDICARE DMEPOS
IN000000111826OtherANTHEM
00001128658 05OtherUNITED HEALTHCARE
IN1171OtherPHYSICIANS HEALTH PLAN
IN100329550Medicaid
4646972OtherAETNA
IN070860LLLLMedicare UPIN
OH2154510Medicaid
IN110175715Medicare PIN
4646972OtherAETNA
IN3937240010OtherMEDICARE DMEPOS