Provider Demographics
NPI:1093017253
Name:BALA, KAMALESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:KAMALESH
Middle Name:KUMAR
Last Name:BALA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2300
Mailing Address - Country:US
Mailing Address - Phone:865-331-1720
Mailing Address - Fax:865-331-2823
Practice Address - Street 1:6387 RAMSEY ST UNIT 140
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9442
Practice Address - Country:US
Practice Address - Phone:910-615-3840
Practice Address - Fax:910-321-6216
Is Sole Proprietor?:No
Enumeration Date:2010-11-21
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP69451207R00000X
VA0101273972207RH0003X
IA40545207RH0003X
TN58677207RH0003X
SC88745207RH0003X
WI101507207RH0003X
NC2019-02784207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093017253Medicaid
TNQ046659Medicaid
IA509280003OtherMEDICARE PTAN