MEDICARE: DR. PRAVEEN CHANDAR BALRAJ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MT191085	PA
2	2086S0129X	Vascular Surgery Physician	4301103519	MI
3	2086S0129X	Vascular Surgery Physician	55078	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447562640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRAVEEN CHANDAR BALRAJ MD

Provider Business Mailing Address
First Line	:	2040 S ALMA SCHOOL RD STE 1
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-7076
Country	:	US
Telephone Number	:	480-936-7722
Fax Number	:	480-936-7723

Provider Business Practice Location Address
First Line	:	21321 E OCOTILLO RD STE 125
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5995
Country	:	US
Telephone Number	:	480-936-7722
Fax Number	:	480-936-7723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/22/2021

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