Provider Demographics
NPI:1093866790
Name:VISWANATHAN, BALU SWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:BALU
Middle Name:SWAMY
Last Name:VISWANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 54182
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453
Mailing Address - Country:US
Mailing Address - Phone:806-792-9863
Mailing Address - Fax:817-900-7666
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:PEDIATRIC INTENSIVE CARE UNIT, UMC HEALTH SYSTEM
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2830208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J07NOtherBLUE CROSS
TX00J07NOtherBLUE CROSS