Healthcare Provider Details

I. General information

NPI: 1114335866
Provider Name (Legal Business Name): ADIL WANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ARCADE AVE STE 400
ELKHART IN
46514-2487
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-2284
  • Fax: 574-522-3952
Mailing address:
  • Phone: 574-647-2129
  • Fax: 574-237-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01085478A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT206382
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: