Provider Demographics
NPI:1962558122
Name:PAI, BALAKRISHNA R (MD)
Entity type:Individual
Prefix:
First Name:BALAKRISHNA
Middle Name:R
Last Name:PAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:19401 HUBBARD DRIVE
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-982-8330
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:19401 HUBBARD DRIVE
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-8330
Practice Address - Fax:313-982-8294
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047447207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP047447OtherCHAMPUS-CHAMPUS
BP047447OtherCOMMERCIAL-COMMERCIAL NUMBER
BP047447OtherCHAMPUS-CHAMPUS