Basic Information
| Provider Information | |||||||||
| NPI: | 1013983790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHALLA | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE ROAD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955042 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 15000 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164721404 | ||||||||
| FaxNumber: | 2165297806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 35078416B | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000593931 | 01 | OH | ANTHEM | OTHER | 9200381 | 01 | UNITED HEALTHCARE | OTHER | C78416 | 01 | SUMMACARE APEX | OTHER | 9273172 | 01 | OH | GROUP MEDICARE PTAN | OTHER | 7007606 | 01 | AETNA | OTHER | 0119204 | 01 | OH | MEDICAID GROUP NUMBER | OTHER | 000000342372 | 01 | ANTHEM | OTHER | 2488099 | 05 | OH | MEDICAID |