Individual
DR. LATHA BALAMUNISWAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
106 19TH AVE, SUITE 103, MOLINE, IL 61265-3700
(309) 779-7050
(309) 764-6269
Mailing address
106 19TH AVE, SUITE 103, MOLINE, IL 61265-3700
(309) 779-7050
(309) 764-6269
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036087173
IL
207Q00000X
Family Medicine Physician
34452
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036087173
BCILLINOIS
—
05
—
036087173002
—
IL
05
—
0575423
—
IA
05
—
1336113992
—
IA
05
—
1575423
—
IA
01
—
80193932
RR MEDICARE
—
Enumeration date
02/13/2006
Last updated
02/05/2015
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