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General NPI Number Information
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NPI Number | 1770688434
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Entity Type | Individual
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Provider Name | KANTILAL BHALANI MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/01/2022
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Provider Practice Location Address
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Address Line | 1663 GEORGIA ST NE STE 400
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City | PALM BAY
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State | FL
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Zip | 32907-2537
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Country | US
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Telephone | 321-802-9080
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Fax | 321-802-5211
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Provider Business Mailing Address
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Address Line | 1663 GEORGIA ST NE STE 500
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City | PALM BAY
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State | FL
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Zip | 32907-2589
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Country | US
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Telephone | 321-802-9080
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Fax | 321-802-5211
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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 | ME39710
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | ME39710
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME39710
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License Number State | FL
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