Basic Information
| Provider Information | |||||||||
| NPI: | 1497722698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PILLAY | ||||||||
| FirstName: | BALAKRISHNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 25200 CENTER RIDGE RD | ||||||||
| Address2: | SUITE 3300 | ||||||||
| City: | WESTLAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441454141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955076 | ||||||||
| FaxNumber: | 4408959250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 01/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35039812P | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000201208 | 01 | ANTHEM | OTHER | 102833 | 01 | KAISER | OTHER | 123833 | 01 | KAISER | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 4007770 | 01 | AETNA | OTHER | 10813526 | 01 | CAQH | OTHER | D368301 | 01 | MEDICARE IND DIAGNOSTICS | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 0398332 | 05 | OH | MEDICAID | CA4511 | 01 | RR MEDICARE GROUP | OTHER |