Healthcare Provider Details

I. General information

NPI: 1235802398
Provider Name (Legal Business Name): HARMANDEEP SINGH PANNU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HIGH ST STE 300
LIMA OH
45801-5914
US

IV. Provider business mailing address

770 W HIGH ST STE 300
LIMA OH
45801-5914
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5033
  • Fax: 419-996-5266
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.156022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: