Provider Demographics
NPI:1447254776
Name:DUBAL, NILESH V (MD)
Entity type:Individual
Prefix:DR
First Name:NILESH
Middle Name:V
Last Name:DUBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD STE 605
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-409-1956
Mailing Address - Fax:
Practice Address - Street 1:1130 HICKORY ST STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-409-1956
Practice Address - Fax:321-409-1253
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1595962085R0001X
TN375062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117331000Medicaid
FLQK112OtherMEDICARE HF
TN3889572Medicaid
TN3889572Medicare ID - Type Unspecified