Provider Demographics
NPI:1194724872
Name:VALIA, BHUPINDER K (MD)
Entity type:Individual
Prefix:DR
First Name:BHUPINDER
Middle Name:K
Last Name:VALIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16115 LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2064
Mailing Address - Country:US
Mailing Address - Phone:708-331-8830
Mailing Address - Fax:708-331-8860
Practice Address - Street 1:16115 LA SALLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2064
Practice Address - Country:US
Practice Address - Phone:708-331-8830
Practice Address - Fax:708-331-8860
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071717Medicaid
IL544440Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
ILE62198Medicare UPIN
IL080154749Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
IL036071717Medicaid