Provider Demographics
NPI:1760682140
Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Entity Type:Organization
Organization Name:ANTELOPE VALLEY LUNG INSTITUTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRADEEP
Authorized Official - Middle Name:BALKRISHNA
Authorized Official - Last Name:DAMLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-945-8717
Mailing Address - Street 1:1331 W AVENUE J
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2942
Mailing Address - Country:US
Mailing Address - Phone:661-945-8717
Mailing Address - Fax:661-945-4867
Practice Address - Street 1:1331 W AVENUE J
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2942
Practice Address - Country:US
Practice Address - Phone:661-945-8717
Practice Address - Fax:661-945-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty