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General NPI Number Information
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NPI Number | 1821320789
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Entity Type | Organization
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Legal Business Name | RAJNEESH K BHALLA MD PA
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 1701 SE HILLMOOR DR SUITE C-12
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7541
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Country | US
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Telephone | 772-398-8844
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Fax | 772-398-0012
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Provider Business Mailing Address
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Address Line | 1701 SE HILLMOOR DR SUITE C-12
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7541
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Country | US
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Telephone | 772-398-8844
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Fax | 772-398-0012
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJNEESH K BHALLA
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Credential | MD
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Telephone | 772-398-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME71005
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License Number State | FL
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