Basic Information
| Provider Information | |||||||||
| NPI: | 1932103264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALIGA | ||||||||
| FirstName: | RAJENDRA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12662 TELECOM DR | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336370935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Practice Location | |||||||||
| Address1: | 4710 N HABANA AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336147143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139108708 | ||||||||
| FaxNumber: | 8558527153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | ME82461 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 269733500 | 05 | FL | MEDICAID |