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General NPI Number Information
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NPI Number | 1851479596
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Entity Type | Individual
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Provider Name | BALACHANDRAN WARIYAR MD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2201 N BROADWELL AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-2153
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Country | US
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Telephone | 402-697-1481
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 S 189TH CT
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City | OMAHA
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State | NE
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Zip | 68130-2835
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Country | US
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Telephone | 402-697-1481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 15438
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License Number State | NE
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