Healthcare Provider Details

I. General information

NPI: 1528268364
Provider Name (Legal Business Name): VARUN MALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

IV. Provider business mailing address

303 W 89TH AVE SUITE E4
MERRILLVILLE IN
46410-6294
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8989
  • Fax:
Mailing address:
  • Phone: 219-769-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.125449
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01069878A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: