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General NPI Number Information
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NPI Number | 1568540680
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Entity Type | Organization
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Legal Business Name | M BALASUBRAMANIAN MD INC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5375 S FORT APACHE RD SUITE 110
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City | LAS VEGAS
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State | NV
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Zip | 89148-7623
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Country | US
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Telephone | 702-597-1597
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Fax | 702-736-1284
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Provider Business Mailing Address
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Address Line | 5375 S FORT APACHE RD SUITE 110
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City | LAS VEGAS
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State | NV
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Zip | 89148-7623
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Country | US
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Telephone | 702-597-1597
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Fax | 702-736-1284
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Authorized Official
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Title or Position | OWNER
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Name | MAHESWARI J BALASUBRAMAINA
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Credential | MD
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Telephone | 702-597-1597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 10258
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License Number State | NV
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