Healthcare Provider Details

I. General information

NPI: 1083614416
Provider Name (Legal Business Name): ELI R HALLAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1964 STATE ST SUITE 100
NEW ALBANY IN
47150-4934
US

IV. Provider business mailing address

1964 STATE ST SUITE 100
NEW ALBANY IN
47150-4934
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-1641
  • Fax: 812-941-0438
Mailing address:
  • Phone: 812-948-1641
  • Fax: 812-941-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01025361A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: