MEDICARE: BALA VISWANATHAN M.D.

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	208600000X	Surgery Physician	G8766	TX

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

General Provider Information

NPI Number	:	1356375976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALA VISWANATHAN M.D.

Provider Business Mailing Address
First Line	:	19260 STONE OAK PKWY
Second Line	:	SUITE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3365
Country	:	US
Telephone Number	:	210-545-5455
Fax Number	:	210-545-0222

Provider Business Practice Location Address
First Line	:	19260 STONE OAK PKWY
Second Line	:	SUITE 102
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3365
Country	:	US
Telephone Number	:	210-545-5455
Fax Number	:	210-545-0222

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/04/2008

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