Provider Demographics
NPI:1538351358
Name:SARAVANAN, BALAJI (MD)
Entity type:Individual
Prefix:
First Name:BALAJI
Middle Name:
Last Name:SARAVANAN
Suffix:
Gender:M
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:BEHAVIORAL HEALTH UNIT
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-3380
Practice Address - Fax:440-960-4017
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0903472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776509Medicaid
OH3025372Medicaid
OH9389631Medicare PIN
OH4219642Medicare PIN
OH7402621Medicare PIN