Provider Demographics
NPI:1770688434
Name:BHALANI, KANTILAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KANTILAL
Middle Name:
Last Name:BHALANI
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 1:1663 GEORGIA ST NE STE 500
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2589
Mailing Address - Country:US
Mailing Address - Phone:321-802-9080
Mailing Address - Fax:321-802-5211
Practice Address - Street 1:1663 GEORGIA ST NE STE 400
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2537
Practice Address - Country:US
Practice Address - Phone:321-802-9080
Practice Address - Fax:321-802-5211
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39710207Q00000X, 207QA0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008258900Medicaid
FL1770688434OtherNPI NUMBER