Provider Demographics
NPI:1154531333
Name:BHALODIA, AMI R (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:R
Last Name:BHALODIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12315 JUDSON RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3277
Mailing Address - Country:US
Mailing Address - Phone:210-646-0890
Mailing Address - Fax:210-646-9191
Practice Address - Street 1:12315 JUDSON RD
Practice Address - Street 2:SUITE 114
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3277
Practice Address - Country:US
Practice Address - Phone:210-646-0890
Practice Address - Fax:210-646-9191
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP4288207ZP0102X
LA201747207ZP0105X, 207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07062Medicaid
LA4P016CW20Medicare PIN
LA07062Medicaid