Healthcare Provider Details

I. General information

NPI: 1912402462
Provider Name (Legal Business Name): HARINI GURRAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 COLUMBIA AVE STE B
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-283-6160
  • Fax: 219-836-6003
Mailing address:
  • Phone: 219-392-7084
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01094024A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: