Individual
DR. SARAVANAN BALAMUTHUSAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2228
(817) 877-5858
(817) 335-4418
Mailing address
1000 W CANNON ST, FORT WORTH, TX 76104-3029
(817) 877-5858
(817) 335-4418
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
201657
LA
207R00000X
Internal Medicine Physician
Q2427
TX
207RN0300X
Nephrology Physician
20565
MS
207RN0300X
Nephrology Physician
43632
AZ
207RN0300X
Nephrology Physician
Primary
Q2427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
342884901
—
TX
Enumeration date
09/24/2007
Last updated
09/02/2022
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