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General NPI Number Information
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NPI Number | 1447562640
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Entity Type | Individual
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Provider Name | PRAVEEN CHANDAR BALRAJ MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 21321 E OCOTILLO RD STE 125
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5995
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Country | US
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Telephone | 480-936-7722
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Fax | 480-936-7723
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Provider Business Mailing Address
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Address Line | 2040 S ALMA SCHOOL RD STE 1
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City | CHANDLER
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State | AZ
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Zip | 85286-7076
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Country | US
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Telephone | 480-936-7722
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Fax | 480-936-7723
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT191085
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 4301103519
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 55078
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License Number State | AZ
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