Healthcare Provider Details

I. General information

NPI: 1568200384
Provider Name (Legal Business Name): PRASHANTH KEKIA'IALOHA BALARAMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

611 OKEEFE AVE APT 3S19
NEW ORLEANS LA
70113-1978
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5263
  • Fax:
Mailing address:
  • Phone: 808-778-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: