Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | L5669 | TX |
NPI | 1053412551 |
---|---|
Provider Name | Diwaker D. Balachandran |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157132503 | (05) | TX |
852500 | BCBS (01) | TX |
H45654 | (02) |