Healthcare Provider Details

I. General information

NPI: 1972728202
Provider Name (Legal Business Name): DARYL L HERSHBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N DETROIT ST
LAGRANGE IN
46761-1147
US

IV. Provider business mailing address

2120 N DETROIT ST
LAGRANGE IN
46761-1147
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2468
  • Fax: 260-463-4237
Mailing address:
  • Phone: 260-463-2468
  • Fax: 260-463-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01037748A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: