Individual
BALAJI SRINIVASAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
35599
IA
207RN0300X
Nephrology Physician
Primary
43728
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34563900
—
WI
Enumeration date
06/09/2005
Last updated
02/02/2016
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