Provider Demographics
NPI:1407868268
Name:SOMAYAJI, BALA S (MD)
Entity Type:Individual
Prefix:
First Name:BALA
Middle Name:S
Last Name:SOMAYAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRIPURA
Other - Middle Name:SUNDARY
Other - Last Name:MANTHA BALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4601 W 109TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-942-0540
Mailing Address - Fax:630-528-9589
Practice Address - Street 1:200 NE 54TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4389
Practice Address - Country:US
Practice Address - Phone:816-799-0180
Practice Address - Fax:630-528-9579
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009012116207RI0200X
KS04-32474207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201112940AMedicaid
MO209452101Medicaid
MO278A00004Medicare Oscar/Certification