Basic Information
| Provider Information | |||||||||
| NPI: | 1730318817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHALANI | ||||||||
| FirstName: | VIRAJ | ||||||||
| MiddleName: | VINAYAK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3140 S FALKENBURG RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | RIVERVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335782574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Practice Location | |||||||||
| Address1: | 12662 TELECOM DR | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2009 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD447055 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 268406 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | ME123975 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.