Provider Demographics
NPI:1144273533
Name:BAL, DALJIT S (MD)
Entity type:Individual
Prefix:
First Name:DALJIT
Middle Name:S
Last Name:BAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6501 W DAILEY ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3770
Mailing Address - Country:US
Mailing Address - Phone:623-773-1161
Mailing Address - Fax:623-773-1181
Practice Address - Street 1:14155 N 83RD AVE
Practice Address - Street 2:STE 122
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5639
Practice Address - Country:US
Practice Address - Phone:623-773-1161
Practice Address - Fax:623-773-1181
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-09-27
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Provider Licenses
StateLicense IDTaxonomies
AZ27357207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ465410Medicaid
AZZ102208Medicare PIN
AZF94682Medicare UPIN