MEDICARE: VIMALI PAUL, MD

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 #
2	DG8519	OTHER		MEDICARE RAILROAD GROUP #

Other Identifiers

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

General Provider Information

NPI Number	:	1790861490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIMALI PAUL, MD

Provider Business Mailing Address
First Line	:	85 DECLARATION DR
Second Line	:	SUITE 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	:	SUITE 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	:	MD, CEO
Name	:	VIMALI PAUL
Credential	:	MD
Telephone Number	:	530-894-6600

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/05/2008

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Practice Location Address:

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Directions to “VIMALI PAUL, MD ” Practice Location

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