Provider Demographics
NPI:1811304157
Name:BAL, INDEEP (MD)
Entity type:Individual
Prefix:
First Name:INDEEP
Middle Name:
Last Name:BAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INDEEP
Other - Middle Name:
Other - Last Name:DHANOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:1990 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9315
Practice Address - Country:US
Practice Address - Phone:360-856-8810
Practice Address - Fax:360-714-2520
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60865597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine