Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 31656 | TN |
Y | 207RN0300X | Nephrologist | 31656 | TN |
NPI | 1154425361 |
---|---|
Provider Name | Ms. Indu Bali |
First Address | Columbia, TN 38401 |
Second Address | Columbia, TN 38401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 14/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3376405 | MEDICARE GROUP NUMBER (01) | TN |
4059771 | (05) | TN |
F93539 | (02) |