Provider Demographics
NPI:1932214830
Name:KAMALAPURKAR, BALU GOVINDRAO (MD)
Entity Type:Individual
Prefix:
First Name:BALU
Middle Name:GOVINDRAO
Last Name:KAMALAPURKAR
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 1:1184 CLEAVER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1143
Mailing Address - Country:US
Mailing Address - Phone:989-282-4003
Mailing Address - Fax:888-491-7220
Practice Address - Street 1:1184 CLEAVER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1143
Practice Address - Country:US
Practice Address - Phone:989-282-4003
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI044635207V00000X
MI4301044635207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932214830Medicaid