Provider Demographics
NPI:1275174781
Name:BALAN, RAMESHBABU (RPT)
Entity Type:Individual
Prefix:MR
First Name:RAMESHBABU
Middle Name:
Last Name:BALAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15667 CRYSTAL DOWNS E
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9639
Mailing Address - Country:US
Mailing Address - Phone:734-773-2326
Mailing Address - Fax:
Practice Address - Street 1:15667 CRYSTAL DOWNS E
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9639
Practice Address - Country:US
Practice Address - Phone:734-773-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist