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General NPI Number Information
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NPI Number | 1619311644
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Entity Type | Individual
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Provider Name | ANKITA DALAL
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Gender | Female
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Dates
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Enumeration Date | 04/22/2013
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 12246 S PULASKI RD
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City | ALSIP
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State | IL
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Zip | 60803-1405
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Country | US
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Telephone | 708-385-5601
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Fax | 708-396-3802
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Provider Business Mailing Address
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Address Line | 12246 S PULASKI RD
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City | ALSIP
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State | IL
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Zip | 60803-1405
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Country | US
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Telephone | 708-385-5601
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Fax | 708-396-3802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301103811
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License Number State | MI
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