Provider Demographics
NPI:1578556486
Name:BALI, SHAMMI K (MD)
Entity Type:Individual
Prefix:
First Name:SHAMMI
Middle Name:K
Last Name:BALI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:SUITE 100 ATTN:CREDENTIALING
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:1100 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:STE 209
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1780
Practice Address - Country:US
Practice Address - Phone:772-204-8889
Practice Address - Fax:772-204-8895
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
FLME 89119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30036OtherBLUE CROSS BLUE SHIELD
FLU2421QMedicare PIN
FLP01288909OtherRAILROAD MEDICARE
FLU2421SMedicare PIN