Healthcare Provider Details

I. General information

NPI: 1285824011
Provider Name (Legal Business Name): BALASUBRAMANYA KOLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 DISCOVERY DR STE 100
LANSING MI
48910
US

IV. Provider business mailing address

804 SERVICE RD STE A202
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-5053
  • Fax: 517-432-4394
Mailing address:
  • Phone: 517-353-5053
  • Fax: 517-432-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301505158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: