Provider Demographics
NPI:1104054162
Name:BALASUNDARAM, NAVEEN (MD)
Entity type:Individual
Prefix:
First Name:NAVEEN
Middle Name:
Last Name:BALASUNDARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:2222 N NEVADA AVE STE 5010
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-776-6700
Practice Address - Fax:719-776-6780
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20170379352086S0129X
COCDRH.00693692086S0129X
KYC09382086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery