Provider Demographics
NPI:1104835842
Name:BALA, RAM SAI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAM
Middle Name:SAI
Last Name:BALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 144333
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-4333
Mailing Address - Country:US
Mailing Address - Phone:407-422-9831
Mailing Address - Fax:407-206-1767
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-1915
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:618-222-4630
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036061463207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL220021775OtherRRR
ILL58826Medicare PIN
IL220021775OtherRRR