Provider Demographics
NPI:1881620292
Name:BALIJA, RAMADEVI (MD)
Entity type:Individual
Prefix:
First Name:RAMADEVI
Middle Name:
Last Name:BALIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5650 N GREEN BAY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4446
Mailing Address - Country:US
Mailing Address - Phone:414-247-9530
Mailing Address - Fax:414-247-1875
Practice Address - Street 1:5650 N GREEN BAY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4446
Practice Address - Country:US
Practice Address - Phone:414-247-9530
Practice Address - Fax:414-247-1875
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI40733-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881620292Medicaid
H46770Medicare UPIN