Provider Demographics
NPI:1740233808
Name:GADHE, BALU (MD)
Entity type:Individual
Prefix:
First Name:BALU
Middle Name:
Last Name:GADHE
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 1:11306 MOUNTAIN VIEW AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3832
Mailing Address - Country:US
Mailing Address - Phone:909-255-0108
Mailing Address - Fax:909-966-4529
Practice Address - Street 1:11306 MOUNTAIN VIEW AVE STE C
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3832
Practice Address - Country:US
Practice Address - Phone:909-255-0108
Practice Address - Fax:909-966-4529
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502580Medicaid
00A502580OtherBLUE SHIELD ID #
045266OtherHEALTH NET ID #
110080893OtherRAILROAD
10178522OtherRAILROAD
CAWA50258DMedicare PIN
00A502580OtherBLUE SHIELD ID #
CAWA50258FMedicare PIN
045266OtherHEALTH NET ID #