Provider Demographics
NPI:1750870499
Name:PALT MED
Entity type:Organization
Organization Name:PALT MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:V
Authorized Official - Last Name:JINDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-260-1394
Mailing Address - Street 1:PO BOX 7677
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-7677
Mailing Address - Country:US
Mailing Address - Phone:812-260-1394
Mailing Address - Fax:812-269-5214
Practice Address - Street 1:800 N BELL TRACE CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4405
Practice Address - Country:US
Practice Address - Phone:512-417-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075098A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty