Provider Demographics
NPI:1912995135
Name:DEOL, HARBANS SINGH (DO)
Entity Type:Individual
Prefix:
First Name:HARBANS
Middle Name:SINGH
Last Name:DEOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000B SOUTH MAIN ST
Mailing Address - Street 2:P.O. BOX 1507
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3740
Mailing Address - Country:US
Mailing Address - Phone:641-472-4156
Mailing Address - Fax:641-472-9436
Practice Address - Street 1:2000B SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3740
Practice Address - Country:US
Practice Address - Phone:641-472-4156
Practice Address - Fax:641-472-9436
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7266536Medicaid
IA37561OtherWELLMARK BCBS PIN
IAG23905Medicare UPIN
IA7266536Medicaid