Healthcare Provider Details

I. General information

NPI: 1174504898
Provider Name (Legal Business Name): BALAGANGADHAR RAO TOTAPALLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-2639
  • Fax: 305-663-0530
Mailing address:
  • Phone: 305-662-2639
  • Fax: 305-663-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number97901875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: