Provider Demographics
NPI:1407825722
Name:DALI, SAMMI M (MD)
Entity type:Individual
Prefix:
First Name:SAMMI
Middle Name:M
Last Name:DALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-4004
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:1507 WABASH ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4300
Practice Address - Country:US
Practice Address - Phone:219-878-8200
Practice Address - Fax:219-878-8331
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057434A207RI0011X, 207R00000X, 207RC0000X
IL036119125207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00605405OtherMEDICARE RR
IN11202879OtherCAQH NUMBER
IN000000560154OtherANTHEM
IN200439020Medicaid
IN5710110004Medicare NSC
IN200439020Medicaid
IN200439020Medicaid