Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 51926 | KY |
N | 208800000X | Urologist | 61525 | WI |
N | 208800000X | Urologist | TP713 | KY |
NPI | 1053573659 |
---|---|
Provider Name | Balaji Kalyanaraman |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Florence, KY 41042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 29/01/2021 |