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General NPI Number Information
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NPI Number | 1104169655
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Entity Type | Individual
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Provider Name | HANI ATALLAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 3809 E 82ND ST STE 13
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-4329
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Country | US
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Telephone | 463-308-5695
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Fax | 317-680-1276
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Provider Business Mailing Address
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Address Line | 2824 CURIE PL
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City | SAN DIEGO
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State | CA
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Zip | 92122-4110
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Country | US
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Telephone | 714-468-8600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A132530
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01095550A
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License Number State | IN
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