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NPI Code Detail

MEDICARE: PRASANTH BALASUBRAMANIAN MD

MEDICARE: PRASANTH BALASUBRAMANIAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianME154073FL
2207RP1001XPulmonary Disease PhysicianME154073FL
3204F00000XTransplant Surgery PhysicianME154073FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033771001
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRASANTH BALASUBRAMANIAN MD
Provider Business Mailing Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number : 904-953-2000
Fax Number :
Provider Business Practice Location Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number : 904-953-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2019
Last Update Date : 01/15/2026

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