Provider Demographics
NPI:1497722698
Name:PILLAY, BALAKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:BALAKRISHNA
Middle Name:
Last Name:PILLAY
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 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:SUITE 3300
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4141
Practice Address - Country:US
Practice Address - Phone:440-895-5076
Practice Address - Fax:440-895-9250
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039812P207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000201208OtherANTHEM
102833OtherKAISER
123833OtherKAISER
1780634279OtherGROUP NPI
3610861OtherGROUP ASC MEDICARE
4007770OtherAETNA
10813526OtherCAQH
D368301OtherMEDICARE IND DIAGNOSTICS
9273172OtherGROUP MEDICARE
0119204OtherGROUP MEDICAID
OH0398332Medicaid
CA4511OtherRR MEDICARE GROUP
4007770OtherAETNA
3610861OtherGROUP ASC MEDICARE