MEDICARE: DR. VIMALI PAUL 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	A53520	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110174445	OTHER		MEDICARE RAILROAD #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700881448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIMALI PAUL M.D.

Provider Business Mailing Address
First Line	:	85 DECLARATION DR
Second Line	:	STE 110
City	:	CHICO
State	:	CA
Zip	:	95973-4902
Country	:	US
Telephone Number	:	530-894-6600
Fax Number	:	530-894-1321

Provider Business Practice Location Address
First Line	:	85 DECLARATION DR
Second Line	:	STE 110
City	:	CHICO
State	:	CA
Zip	:	95973-4902
Country	:	US
Telephone Number	:	530-894-6600
Fax Number	:	530-894-1321

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/04/2011

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