Healthcare Provider Details

I. General information

NPI: 1184012130
Provider Name (Legal Business Name): HARI RASAD GOURABATHINI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N MICHIGAN ST 5TH FL
SOUTH BEND IN
46601-1033
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-7275
  • Fax: 574-647-3696
Mailing address:
  • Phone: 574-647-1610
  • Fax: 574-237-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01074968A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01074968A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: