Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME39710 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME39710 | FL |
N | 207V00000X | Obstetrician & Gynecologist | ME39710 | FL |
NPI | 1770688434 |
---|---|
Provider Name | Dr. Kantilal Bhalani |
First Address | Titusville, FL 32796-2100 |
Second Address | Palm Bay, FL 32907-2537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008258900 | (05) | FL |
1770688434 | NPI NUMBER (01) | FL |