Healthcare Provider Details

I. General information

NPI: 1902605231
Provider Name (Legal Business Name): PETER HALLORAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 11TH ST
INDIANAPOLIS IN
46202-4108
US

IV. Provider business mailing address

350 W 11TH ST
INDIANAPOLIS IN
46202-4108
US

V. Phone/Fax

Practice location:
  • Phone: 708-267-8654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number11025137A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: