Provider Demographics
NPI:1396730263
Name:BALAJI, HARIGOPAL (MD)
Entity type:Individual
Prefix:DR
First Name:HARIGOPAL
Middle Name:
Last Name:BALAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3873
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:216-791-0021
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3873
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-791-0021
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2232604Medicaid
OHH32848Medicare UPIN
OHBA4043921Medicare ID - Type Unspecified