Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125051809 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036.123743 | IL |
NPI | 1013171636 |
---|---|
Provider Name | Dr. Ajay K Balaram |
First Address | Arlington Heights, IL 60005-4439 |
Second Address | Arlington Heights, IL 60005-4439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2008 |
Last Update Date | 11/11/2012 |