Provider Demographics
NPI:1174500607
Name:DALAL, BANKIM H (MD)
Entity Type:Individual
Prefix:DR
First Name:BANKIM
Middle Name:H
Last Name:DALAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277
Mailing Address - Country:US
Mailing Address - Phone:559-635-2262
Mailing Address - Fax:559-635-2252
Practice Address - Street 1:1622 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-635-2262
Practice Address - Fax:559-635-2252
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51130207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100016409OtherMEDICARE RAILROAD
OH0598125Medicaid
CA0598125Medicaid
OH0598125Medicaid
OH100016409OtherMEDICARE RAILROAD
CA0570012Medicare PIN
CAA82177Medicare UPIN