MEDICARE: DR. RANGA BALASEKARAN 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	207RG0100X	Gastroenterology Physician	K5792	TX
2	207RG0100X	Gastroenterology Physician	E7733	AR

General Provider Information

NPI Number	:	1518965813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANGA BALASEKARAN MD

Provider Business Mailing Address
First Line	:	601 W MAPLE AVE
Second Line	:	SUITE 213
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5335
Country	:	US
Telephone Number	:	479-757-8150
Fax Number	:	479-757-8155

Provider Business Practice Location Address
First Line	:	601 W MAPLE AVE
Second Line	:	SUITE 213
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5335
Country	:	US
Telephone Number	:	479-757-8150
Fax Number	:	479-757-8155

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	09/02/2020

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