Provider Demographics
NPI:1376233403
Name:BALASUBRAMANIAN, PRADEEP (MD)
Entity Type:Individual
Prefix:MR
First Name:PRADEEP
Middle Name:
Last Name:BALASUBRAMANIAN
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:GME, DETROIT MEDICAL CENTER, 4201 ST ANTOINE, UHC 9C
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5147
Mailing Address - Fax:
Practice Address - Street 1:TRANSITIONAL MEDICINE PROGRAM, DEPARTMENT OF MEDICINE,
Practice Address - Street 2:6071 W. OUTER DRIVE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235
Practice Address - Country:US
Practice Address - Phone:313-966-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program