Provider Demographics
NPI:1811939606
Name:BALASUBRAMANIAN, ANAND (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:
Last Name:BALASUBRAMANIAN
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:PO BOX 90967
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77290-0967
Mailing Address - Country:US
Mailing Address - Phone:832-239-7398
Mailing Address - Fax:
Practice Address - Street 1:837 CYPRESS CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3424
Practice Address - Country:US
Practice Address - Phone:281-893-8100
Practice Address - Fax:281-271-8457
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190511901Medicaid
TXI04507Medicare UPIN
TX8B8046Medicare ID - Type Unspecified