Individual
PARUL G PATHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1160 JOLIET ST, SUITE 103, DYER, IN 46311-2096
(219) 322-8534
(219) 865-9072
Mailing address
1160 JOLIET ST, SUITE 103, DYER, IN 46311-2096
(219) 322-8534
(219) 865-9072
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01057543A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200444360
—
IN
01
—
32-0149967
EMPLOYER TAX ID
IN
Enumeration date
08/16/2005
Last updated
05/05/2015
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