Healthcare Provider Details

I. General information

NPI: 1518510312
Provider Name (Legal Business Name): HANAN TAHIR LODHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD 4TH FLOOR HOSPITALISTS STE
ELKHART IN
46514-2483
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-389-7393
  • Fax: 574-647-1094
Mailing address:
  • Phone: 574-647-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01088623A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01088623A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: