Provider Demographics
NPI:1194767467
Name:BALINDER S. CHAHAL, MD., PA
Entity type:Organization
Organization Name:BALINDER S. CHAHAL, MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-804-8016
Mailing Address - Street 1:1355 S INTERNATIONAL PKWY
Mailing Address - Street 2:#2491
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1696
Mailing Address - Country:US
Mailing Address - Phone:407-804-8016
Mailing Address - Fax:407-804-8017
Practice Address - Street 1:1355 S INTERNATIONAL PKWY
Practice Address - Street 2:#2491
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1696
Practice Address - Country:US
Practice Address - Phone:407-804-8016
Practice Address - Fax:407-804-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00607812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374756500Medicaid
FL15205BMedicare ID - Type UnspecifiedDR.'S MEDICARE #
FLF34608Medicare UPIN