Provider Demographics
NPI:1770692337
Name:LAL, NAVEEN (MD)
Entity type:Individual
Prefix:
First Name:NAVEEN
Middle Name:
Last Name:LAL
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 1:604 W BERRY ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2106
Mailing Address - Country:US
Mailing Address - Phone:260-423-1331
Mailing Address - Fax:260-422-1046
Practice Address - Street 1:604 W BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2106
Practice Address - Country:US
Practice Address - Phone:260-423-1331
Practice Address - Fax:260-422-1046
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050563A207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200237610AMedicaid
IN141360DMedicare ID - Type Unspecified