Provider Demographics
NPI:1043768351
Name:WILLIAMS, KALAISELVI BALASUBRAMANIAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KALAISELVI
Middle Name:BALASUBRAMANIAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:SELVI
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-7943
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # L475
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-6551
Practice Address - Fax:503-494-0979
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD239382083P0901X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine