Provider Demographics
NPI:1447243258
Name:DUGGAL, MANOJ (MD,FACC)
Entity type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:DUGGAL
Suffix:
Gender:M
Credentials:MD,FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:12750 SAINT FRANCIS DR STE 320
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-0264
Practice Address - Country:US
Practice Address - Phone:219-662-0077
Practice Address - Fax:219-662-9496
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085016207RC0001X
IN01094306A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085016Medicaid
IL21622931OtherBCBS GROUP #
IL060053840OtherPALMETTO GBA INDIVIDUAL #
ILCI8250OtherPALMETTO GBA GROUP #
ILG39337Medicare UPIN
IL526200Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILL68056Medicare ID - Type UnspecifiedMEDICARE INDIV PROV ID #
IL388180Medicare ID - Type UnspecifiedANOTHER MEDICARE GROUP #
ILL68056Medicare PIN