Healthcare Provider Details

I. General information

NPI: 1154531333
Provider Name (Legal Business Name): AMI R BHALODIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4386
US

IV. Provider business mailing address

10810 EXECUTIVE CENTER DR STE 100
LITTLE ROCK AR
72211-4386
US

V. Phone/Fax

Practice location:
  • Phone: 501-604-2695
  • Fax: 501-604-2699
Mailing address:
  • Phone: 501-604-2695
  • Fax: 501-604-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number201747
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number201747
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberE-20608
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: