Provider Demographics
NPI:1306893516
Name:MITTAL, RAM LAL (MD)
Entity type:Individual
Prefix:
First Name:RAM
Middle Name:LAL
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7215 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2969
Mailing Address - Country:US
Mailing Address - Phone:559-449-0309
Mailing Address - Fax:559-449-0609
Practice Address - Street 1:7215 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2969
Practice Address - Country:US
Practice Address - Phone:559-449-0309
Practice Address - Fax:559-449-0609
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48570207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485700Medicaid
CA00A485700Medicare ID - Type Unspecified
C44562Medicare UPIN