Balamuniswamy, Latha

Balamuniswamy, Latha is an individual health care provider with primary practice located at 106 19Th Ave Suite 103, Moline IL 61265-3700. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Balamuniswamy, Latha can be contacted via phone (309) 779-7050.

Contact Information

Primary practice address
106 19Th Ave Suite 103 Moline IL 61265-3700
Phone: (309) 779-7050
Fax: (309) 764-6269
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036087173 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 34452 Iowa

Profile Details

NPI number 1336113992
LBN Legal business name Balamuniswamy, Latha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Feb 5th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336113992 NPPES
Other 036087173 BCILLINOIS
MEDICAID 0575423 BCILLINOIS
MEDICAID 036087173002 BCILLINOIS
MEDICAID 1336113992 BCILLINOIS
MEDICAID 1575423 BCILLINOIS
Other 80193932 BCILLINOIS

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