Individual
PRASANTH BALASUBRAMANIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
Primary
ME154073
FL
207RP1001X
Pulmonary Disease Physician
ME154073
FL
208600000X
Surgery Physician
ME154073
FL
Other
Enumeration date
07/01/2019
Last updated
01/15/2026
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