Provider Demographics
NPI:1346536380
Name:BALA, RAJESH M (DO)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:M
Last Name:BALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E OHIO ST
Mailing Address - Street 2:APT. 2602
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3375
Mailing Address - Country:US
Mailing Address - Phone:661-472-1233
Mailing Address - Fax:
Practice Address - Street 1:345 E OHIO ST
Practice Address - Street 2:APT. 2602
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3375
Practice Address - Country:US
Practice Address - Phone:661-472-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-059156207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine