MEDICARE: DR. PRANAVKUMAR DALAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-116861	IL
2	207RN0300X	Nephrology Physician	036116861	IL

General Provider Information

NPI Number	:	1083811293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRANAVKUMAR DALAL M.D.

Provider Business Mailing Address
First Line	:	6530 TROOST AVE
Second Line	:	SUITE A
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1230
Country	:	US
Telephone Number	:	816-361-0670
Fax Number	:

Provider Business Practice Location Address
First Line	:	6530 TROOST AVE
Second Line	:	SUITE A
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-1230
Country	:	US
Telephone Number	:	816-361-0670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	02/20/2014

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