Healthcare Provider Details

I. General information

NPI: 1447578927
Provider Name (Legal Business Name): PREETHI BALAKRISHNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2010
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

800 5TH AVE STE 600
SEATTLE WA
98104-3186
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2520
  • Fax: 206-215-6364
Mailing address:
  • Phone: 206-320-2103
  • Fax: 206-320-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD60967138
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: