Individual provider · NPI-1

Chindo Bala Mallum, MD

Psychiatry & Neurology, Neurology · Terre Haute, IN

NPI number1669968160
StatusActive
Last updated in NPPESOct 1, 2024

Details

NPI
1669968160
Entity type
Individual (NPI-1)
Name
Chindo Bala Mallum
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Jul 8, 2018
Certification date
Oct 1, 2024
Last updated
Oct 1, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084N0400X Psychiatry & Neurology, Neurology01089078AINYes

Practice location

1606 N 7th St
Terre Haute, IN 47804-2706

Phone 812-242-3125

Mailing address

1739 N 4th St
Terre Haute, IN 47804-4002

Phone 812-242-3125 · Fax 812-242-3446

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