Healthcare Provider Details

I. General information

NPI: 1720024615
Provider Name (Legal Business Name): DALAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 CALUMET AVE STE 401
MUNSTER IN
46321-0018
US

IV. Provider business mailing address

9410 CALUMET AVE STE 401
MUNSTER IN
46321-0018
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-4900
  • Fax: 219-836-9922
Mailing address:
  • Phone: 219-922-4900
  • Fax: 219-836-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: JASON L BAKER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 219-682-0464