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NPI Code Detail

MEDICARE: PRAKASH BALAN M.D.

MEDICARE: PRAKASH BALAN M.D.
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
1207R00000XInternal Medicine Physician279809AZ
2207RC0000XCardiovascular Disease Physician279809AZ
3207RI0011XInterventional Cardiology Physician279809AZ

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 : 1285830661
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRAKASH BALAN M.D.
Provider Business Mailing Address
First Line : 2487 S GILBERT RD STE 106-486
Second Line :
City : GILBERT
State : AZ
Zip : 85295-8899
Country : US
Telephone Number : 480-699-5536
Fax Number : 480-699-9283
Provider Business Practice Location Address
First Line : 2100 E YEAGER DR
Second Line :
City : CHANDLER
State : AZ
Zip : 85286-1598
Country : US
Telephone Number : 480-699-5536
Fax Number : 480-699-9283
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2007
Last Update Date : 03/09/2026

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