Provider Demographics
NPI:1215011747
Name:BALAKRISHNA, SAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:SAVITHA
Middle Name:
Last Name:BALAKRISHNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-632-2777
Mailing Address - Fax:936-632-5819
Practice Address - Street 1:525 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-632-2777
Practice Address - Fax:936-632-5819
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6129OtherBLUE CROSS
TX187394501Medicaid
TX8F6129OtherBLUE CROSS
TX8J4849Medicare PIN