Provider Demographics
NPI:1487736526
Name:HARBANS DEOL DO PHD PC
Entity type:Organization
Organization Name:HARBANS DEOL DO PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARBANS
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-919-7650
Mailing Address - Street 1:902 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3839
Mailing Address - Country:US
Mailing Address - Phone:641-472-9191
Mailing Address - Fax:
Practice Address - Street 1:600 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-5012
Practice Address - Country:US
Practice Address - Phone:641-472-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15712OtherBLUE CROSS BLUE SHIELD IA
IA9134106Medicaid
IA2266536Medicaid
IA15712OtherBLUE CROSS BLUE SHIELD IA
IAG23905Medicare UPIN