Healthcare Provider Details

I. General information

NPI: 1396993184
Provider Name (Legal Business Name): NIKHIL BALAKRISHNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 03/09/2023
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E W T HARRIS BLVD STE 5202
CHARLOTTE NC
28262-3485
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-863-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2008-02056
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2008-02056
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: