MEDICARE: VIDUR BHALLA

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	390200000X	Student in an Organized Health Care Education/Training Program		IL
2	207Y00000X	Otolaryngology Physician	2017022363	MO

General Provider Information

NPI Number	:	1144586124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDUR BHALLA

Provider Business Mailing Address
First Line	:	901 E 104TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4517
Country	:	US
Telephone Number	:	816-502-7000
Fax Number	:	816-932-7957

Provider Business Practice Location Address
First Line	:	4320 WORNALL RD STE 512
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3235
Country	:	US
Telephone Number	:	816-932-8663
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	01/15/2019

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Directions to “ VIDUR BHALLA ” Practice Location

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