Provider Demographics
NPI:1881655439
Name:LALLI, BALDEV S (MD)
Entity Type:Individual
Prefix:DR
First Name:BALDEV
Middle Name:S
Last Name:LALLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1950 LEE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1859
Mailing Address - Country:US
Mailing Address - Phone:407-647-2346
Mailing Address - Fax:407-647-5431
Practice Address - Street 1:1950 LEE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1859
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:407-647-5431
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME69509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL220558OtherAVMED
FL28934OtherBCBS
FLP00276700OtherRAIL ROAD MEDICARE
FLP00276700OtherRAIL ROAD MEDICARE
FLG40316Medicare UPIN