Basic Information
| Provider Information | |||||||||
| NPI: | 1467799577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHRI BALAJI MEDICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4123 UNIVERSITY BLVD S STE C | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047047140 | ||||||||
| FaxNumber: | 8886554672 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 UNIVERSITY BLVD S | ||||||||
| Address2: | SUITE C | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047047140 | ||||||||
| FaxNumber: | 8666838679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2013 | ||||||||
| LastUpdateDate: | 07/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | RAJPAL | ||||||||
| AuthorizedOfficialFirstName: | CHITRA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9047047140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME108505 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.