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:
Health care specialties
| Specialty | Code | License # | 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 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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