Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | M3882 | TX |
NPI | 1063433381 |
---|---|
Provider Name | Dr. Lakshmi Balasubramanian |
First Address | Dallas, TX 75391-1230 |
Second Address | Cedar Park, TX 78613-5026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
183001001 | (05) | TX |
183001002 | (05) | TX |
183001003 | (05) | TX |
8W4990 | BLUECROSS BLUE SHIELD (01) | TX |
I65279 | (02) | TX |