Provider Demographics
NPI:1366507535
Name:BHUPINDER K. VALIA MD SER CORP
Entity Type:Organization
Organization Name:BHUPINDER K. VALIA MD SER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:VALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-331-8830
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4179
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:16115 LA SALLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2064
Practice Address - Country:US
Practice Address - Phone:708-331-8830
Practice Address - Fax:708-331-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635595OtherBLUE SHIELD PPO
IL01635595OtherBLUE SHIELD PPO
ILK21969Medicare PIN
ILP00271096Medicare PIN