Provider Demographics
NPI:1700812823
Name:DALAL, HARSHAVARDHAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHAVARDHAN
Middle Name:L
Last Name:DALAL
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 1:9731 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054886207RG0100X, 208C00000X
IN01029392A208C00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086035OtherBCBS OF IN
IL21609752OtherBCBS OF IL
IN100213290AMedicaid
B29109Medicare UPIN
IN705400AMedicare PIN