Healthcare Provider Details

I. General information

NPI: 1881008647
Provider Name (Legal Business Name): AHRARUL HAQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N DETROIT ST
LAGRANGE IN
46761-1158
US

IV. Provider business mailing address

PO BOX 236
LAGRANGE IN
46761-0236
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2133
  • Fax: 260-463-3775
Mailing address:
  • Phone: 260-463-2133
  • Fax: 260-463-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01091741A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50239
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01091741A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: