Provider Demographics
NPI:1992847669
Name:BALIGA, BANTWAL SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:BANTWAL
Middle Name:SURESH
Last Name:BALIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3320 SKYWAY DR
Mailing Address - Street 2:SUITE 808
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-7137
Mailing Address - Country:US
Mailing Address - Phone:334-737-2737
Mailing Address - Fax:334-821-1043
Practice Address - Street 1:3320 SKYWAY DR
Practice Address - Street 2:SUITE 808
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-7137
Practice Address - Country:US
Practice Address - Phone:334-737-2737
Practice Address - Fax:334-821-1043
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA056680207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH53393Medicare UPIN