MEDICARE: DR. VIKRAM ADITYA BALA DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4143	FL

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	:	1518490069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKRAM ADITYA BALA DPM

Provider Business Mailing Address
First Line	:	5911 TIMUQUANA RD UNIT 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7897
Country	:	US
Telephone Number	:	904-251-5053
Fax Number	:	904-224-2002

Provider Business Practice Location Address
First Line	:	1914 SOUTHSIDE BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1997
Country	:	US
Telephone Number	:	904-726-9901
Fax Number	:	904-224-2002

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	08/29/2023

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