Provider Demographics
NPI:1659370161
Name:BALANOFF, CHRISTA RUBLE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:RUBLE
Last Name:BALANOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:ANN
Other - Last Name:RUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10787 NALL AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1375
Mailing Address - Country:US
Mailing Address - Phone:913-945-9400
Mailing Address - Fax:913-945-9410
Practice Address - Street 1:10787 NALL AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1375
Practice Address - Country:US
Practice Address - Phone:913-945-9400
Practice Address - Fax:913-945-9410
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31985208600000X
MO2006018662208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200195500Medicaid
IN1009224OtherTRICARE
H55142Medicare UPIN
IN333030HMedicare ID - Type Unspecified