Provider Demographics
NPI:1154425361
Name:BALI, INDU (MD)
Entity type:Individual
Prefix:MS
First Name:INDU
Middle Name:
Last Name:BALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 HATCHER LANE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-9388
Mailing Address - Fax:931-388-9808
Practice Address - Street 1:1394 HATCHER LANE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-388-9388
Practice Address - Fax:931-388-9808
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31656207QA0505X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376405OtherMEDICARE GROUP NUMBER
TN4059771Medicaid
F93539Medicare UPIN
TN3376405OtherMEDICARE GROUP NUMBER