Individual
PRIYANKHA BALASUNDARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3410 W 19TH AVE, STILLWATER, OK 74074-2732
(405) 252-1850
(405) 999-4775
Mailing address
3410 W 19TH AVE, STILLWATER, OK 74074-2732
(405) 252-1850
(405) 999-4775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30838
OK
208600000X
Surgery Physician
125055402
IL
208600000X
Surgery Physician
BT4601692-8387
LA
Other
Enumeration date
11/09/2007
Last updated
05/07/2025
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