Individual
BALA BHAGAVATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2365 DEMING WAY, MIDDLETON, WI 53562-5512
(608) 824-6160
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
267127
NY
207VE0102X
Reproductive Endocrinology Physician
Primary
72546-20
WI
207VE0102X
Reproductive Endocrinology Physician
MD12320
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03508014
—
NY
Enumeration date
06/20/2007
Last updated
01/25/2021
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