Healthcare Provider Details

I. General information

NPI: 1417074238
Provider Name (Legal Business Name): MRS. DIPALI SURESH GOHIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 OLD SPRINGVILLE RD SUITE 104
BIRMINGHAM AL
35215-5858
US

IV. Provider business mailing address

33460 BARDOLPH CIR
FREMONT CA
94555-2042
US

V. Phone/Fax

Practice location:
  • Phone: 205-520-9600
  • Fax:
Mailing address:
  • Phone: 510-364-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number5501013009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: