Provider Demographics
NPI:1639212400
Name:BALANI, EKTA (DPM)
Entity Type:Individual
Prefix:DR
First Name:EKTA
Middle Name:
Last Name:BALANI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:EKTA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:358 S LIVERMORE AVE
Mailing Address - Street 2:STE 308
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4654
Mailing Address - Country:US
Mailing Address - Phone:510-927-6584
Mailing Address - Fax:510-686-8786
Practice Address - Street 1:358 S LIVERMORE AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4654
Practice Address - Country:US
Practice Address - Phone:510-927-6584
Practice Address - Fax:510-686-8786
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4668213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFR576ZMedicare UPIN