Individual
DR. NIVAS BALASUBRAMANIYAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
01078328A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001090890
ANTHEM PROVIDER NUMBER
—
05
—
300004342
—
IN
Enumeration date
09/17/2009
Last updated
07/21/2022
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