Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 4301072119 | MI |
NPI | 1083696694 |
---|---|
Provider Name | Dr. Savitha Balaraman |
First Address | Madison Heights, MI 48071-3473 |
Second Address | Madison Heights, MI 48071-3473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 25/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
465867410 | (05) | MI |
I20169 | (02) |