Basic Information
Provider Information
NPI: 1033557830
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MINHAS
FirstName: HARDEEP
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: D.P.M.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2338 DIVAC DR
Address2:  
City: SCHERERVILLE
State: IN
PostalCode: 463754304
CountryCode: US
TelephoneNumber: 8474546469
FaxNumber:  
Practice Location
Address1: 2308 ROOSEVELT RD
Address2:  
City: VALPARAISO
State: IN
PostalCode: 463832773
CountryCode: US
TelephoneNumber: 2193154458
FaxNumber: 2195950570
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 11/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X07001228AINY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
213ES0103X135000803ILN Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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