Healthcare Provider Details

I. General information

NPI: 1568859007
Provider Name (Legal Business Name): VARUN BHALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13943 N 91ST AVE BLDG 1
PEORIA AZ
85381
US

IV. Provider business mailing address

13943 N 91ST AVE BLDG 1
PEORIA AZ
85381
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2690
  • Fax: 623-815-2689
Mailing address:
  • Phone: 623-815-2690
  • Fax: 623-815-2689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2943681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036.152107
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number65843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: