Provider Demographics
NPI:1013983790
Name:BHALLA, ANITA (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5042
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:15000 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-472-1404
Practice Address - Fax:216-529-7806
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078416B207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000593931OtherANTHEM
9200381OtherUNITED HEALTHCARE
C78416OtherSUMMACARE APEX
OH9273172OtherGROUP MEDICARE PTAN
7007606OtherAETNA
OH0119204OtherMEDICAID GROUP NUMBER
000000342372OtherANTHEM
OH2488099Medicaid
4127425Medicare PIN
C78416OtherSUMMACARE APEX
OH9273172OtherGROUP MEDICARE PTAN
OH2488099Medicaid