Provider Demographics
NPI:1932211406
Name:NAPA, BALASUBRAMANYAN (MD)
Entity Type:Individual
Prefix:
First Name:BALASUBRAMANYAN
Middle Name:
Last Name:NAPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BALA
Other - Middle Name:
Other - Last Name:NAPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-902-5291
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI362322080P0203X
IA324472080P0203X
KS04-378802080P0203X
IL0361417662080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201116270AMedicaid
IA1171561Medicaid
IA45651OtherWELLMARK
KSKA2129031OtherMEDICARE PTAN
IAI10521Medicare PIN