Provider Demographics
NPI:1649224577
Name:BALIGA, SHWETA (MD)
Entity Type:Individual
Prefix:
First Name:SHWETA
Middle Name:
Last Name:BALIGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARKAL SHWETHA
Other - Middle Name:SURESH
Other - Last Name:HEGDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:STE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-289-3100
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:STE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-289-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7168737OtherAETNA PROVIDER NUMBER
WA911203494CAOtherKPS PROVIDER NUMBER
WA8154HEOtherREGENCE RIDER NUMBER
WA98375B016OtherTRICARE PROVIDER NUMBER
WA0195418OtherL & I PROVIDER NUMBER
WA8423964Medicaid
WA0195418OtherL & I PROVIDER NUMBER