Healthcare Provider Details

I. General information

NPI: 1942226907
Provider Name (Legal Business Name): KIRIT BHALANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CLYDE MORRIS BLVD SUITE 400
ORMOND BEACH FL
32174
US

IV. Provider business mailing address

325 CLYDE MORRIS BLVD SUITE 400
ORMOND BEACH FL
32174-8178
US

V. Phone/Fax

Practice location:
  • Phone: 386-671-0600
  • Fax: 386-677-9710
Mailing address:
  • Phone: 386-671-0600
  • Fax: 386-677-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME69468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: