Provider Demographics
NPI:1942226907
Name:BHALANI, KIRIT (MD)
Entity Type:Individual
Prefix:
First Name:KIRIT
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 1:325 CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8178
Mailing Address - Country:US
Mailing Address - Phone:386-671-0600
Mailing Address - Fax:386-677-9710
Practice Address - Street 1:325 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-671-0600
Practice Address - Fax:386-677-9710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69468207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015306200Medicaid
FL28294OtherBCBS
FL250637800Medicaid
FL1740385350OtherMEDICARE DME ORMAND BEACH
FLP00447032OtherRR MEDICARE
FL1811363732OtherMEDICARE DME WESLEY CHAPEL LOCATION
FL28294WMedicare PIN
FL28294DMedicare PIN
FL28294OtherBCBS