Basic Information
| Provider Information | |||||||||
| NPI: | 1295911584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALAKRISHNAN | ||||||||
| FirstName: | MAYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1504 TAUB LOOP | ||||||||
| Address2: | 5TH FLOOR GASTROENTEROLOGY | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138733503 | ||||||||
| FaxNumber: | 7138733505 | ||||||||
| Practice Location | |||||||||
| Address1: | 1504 TAUB LOOP | ||||||||
| Address2: | 5TH FLOOR GASTROENTEROLOGY | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138733503 | ||||||||
| FaxNumber: | 7138733505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 03/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | N8270 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 208M00000X | 047673 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.