Provider Demographics
NPI:1275501363
Name:KERALAVARMA, BALAGOPAL (MD)
Entity Type:Individual
Prefix:
First Name:BALAGOPAL
Middle Name:
Last Name:KERALAVARMA
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 1:8127 MERRILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6158
Mailing Address - Country:US
Mailing Address - Phone:219-924-3232
Mailing Address - Fax:219-757-5629
Practice Address - Street 1:8554 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-750-9581
Practice Address - Fax:219-750-9781
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052677A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200292720Medicaid
IN5171410002OtherDMERC
IN200292720Medicaid
IN218800GMedicare ID - Type Unspecified