MEDICARE: PRATAP BALUSU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	72413	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000024961	OTHER		ANTHEM

General Provider Information

NPI Number	:	1083607519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATAP BALUSU MD

Provider Business Mailing Address
First Line	:	PO BOX 636930
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-981-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 W HIGH ST
Second Line	:	STE 250
City	:	LIMA
State	:	OH
Zip	:	45801-3959
Country	:	US
Telephone Number	:	419-227-7399
Fax Number	:	419-229-0123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	10/31/2014

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Directions to “ PRATAP BALUSU MD” Practice Location

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