Provider Demographics
NPI:1972705754
Name:BALAPALA, KIRANMAYE (MD)
Entity Type:Individual
Prefix:
First Name:KIRANMAYE
Middle Name:
Last Name:BALAPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22001 SOUTHWEST FWAY SUITE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469
Mailing Address - Country:US
Mailing Address - Phone:832-595-7700
Mailing Address - Fax:
Practice Address - Street 1:22001 SOUTHWEST FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7001
Practice Address - Country:US
Practice Address - Phone:832-595-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201659207Q00000X
TXP5930207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1071188Medicaid
LA4K803F996Medicare PIN