Provider Demographics
NPI:1285830661
Name:BALAN, PRAKASH (MD)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:
Last Name:BALAN
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 1:2487 S GILBERT RD STE 106-486
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8899
Mailing Address - Country:US
Mailing Address - Phone:480-699-5536
Mailing Address - Fax:480-699-9283
Practice Address - Street 1:2100 E YEAGER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1598
Practice Address - Country:US
Practice Address - Phone:480-699-5536
Practice Address - Fax:480-699-9283
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-117301207R00000X
AZ279809207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease