Healthcare Provider Details

I. General information

NPI: 1205949237
Provider Name (Legal Business Name): HANI MICHAEL MAROGIL DR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 FORT HARRISON RD
TERRE HAUTE IN
47804-1413
US

IV. Provider business mailing address

12231 N MOORES CT
CAMBY IN
46113-8536
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-5500
  • Fax:
Mailing address:
  • Phone: 303-579-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7330
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12013290A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12013290A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: