Provider Demographics
NPI:1396786273
Name:BALACHANDRAN, JAY SHANKAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:SHANKAR
Last Name:BALACHANDRAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-5044
Practice Address - Fax:262-243-2510
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-11-07
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Provider Licenses
StateLicense IDTaxonomies
WI64930207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1396786273Medicaid
WIK400266197Medicare PIN