Individual
DR. GAUTAM BALAKRISHNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5301 FARAON ST STE 210B, SAINT JOSEPH, MO 64506
(816) 271-1385
(816) 271-1379
Mailing address
5301 FARAON ST STE 210B, SAINT JOSEPH, MO 64506-3512
(816) 271-1385
(816) 271-1379
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R9809
IA
207RP1001X
Pulmonary Disease Physician
Primary
2016023333
MO
Other
Enumeration date
06/13/2013
Last updated
05/26/2021
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