Provider Demographics
NPI:1023152311
Name:SURESH BALENALLI, PLLC
Entity type:Organization
Organization Name:SURESH BALENALLI, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:BALENALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-251-1067
Mailing Address - Street 1:PO BOX 13308
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0039
Mailing Address - Country:US
Mailing Address - Phone:520-836-6636
Mailing Address - Fax:520-836-6846
Practice Address - Street 1:1968 N PEART RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2495
Practice Address - Country:US
Practice Address - Phone:520-836-6636
Practice Address - Fax:520-836-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28920261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH48499Medicare UPIN