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Individual

ANITA BHALLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
15000 MADISON AVE, LAKEWOOD, OH 44107
(216) 472-1404
(216) 529-7806
Mailing address
20525 CENTER RIDGE ROAD, SUITE 220, ROCKY RIVER, OH 44116
(440) 895-5042
(440) 333-2935

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
35078416B
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000342372
ANTHEM
01
000000593931
ANTHEM
OH
01
0119204
MEDICAID GROUP NUMBER
OH
05
2488099
OH
01
7007606
AETNA
01
9200381
UNITED HEALTHCARE
01
9273172
GROUP MEDICARE PTAN
OH
01
C78416
SUMMACARE APEX
Enumeration date
02/23/2006
Last updated
04/23/2009
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