Provider Demographics
NPI:1134150808
Name:INDRA PAL MDSC
Entity type:Organization
Organization Name:INDRA PAL MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:INDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-672-0567
Mailing Address - Street 1:104 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2899
Mailing Address - Country:US
Mailing Address - Phone:815-672-0567
Mailing Address - Fax:815-672-8933
Practice Address - Street 1:104 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364
Practice Address - Country:US
Practice Address - Phone:815-674-0567
Practice Address - Fax:815-672-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty