Provider Demographics
NPI:1205115128
Name:JAIKRISHNA BALKISSON,MD & LAURIE E. SCHWEITZER, MD
Entity type:Organization
Organization Name:JAIKRISHNA BALKISSON,MD & LAURIE E. SCHWEITZER, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANGELIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DURANO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:510-548-1717
Mailing Address - Street 1:2999 REGENT STREET
Mailing Address - Street 2:300
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-548-1717
Mailing Address - Fax:
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:300
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-548-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG713950174400000X
CAG713630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36983Medicare UPIN
CAF39557Medicare UPIN