Healthcare Provider Details

I. General information

NPI: 1679886709
Provider Name (Legal Business Name): KESHAWADHANA BALAKRISHNAN M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SHERIDAN STREET M
HOLLYWOOD FL
33021-3420
US

IV. Provider business mailing address

9500 S DADELAND BLVD 200
MIAMI FL
33156-2866
US

V. Phone/Fax

Practice location:
  • Phone: 305-468-4185
  • Fax: 305-675-3378
Mailing address:
  • Phone: 305-468-4185
  • Fax: 305-675-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberME133661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: