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General NPI Number Information
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NPI Number | 1467799577
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Entity Type | Organization
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Legal Business Name | SHRI BALAJI MEDICAL SERVICES
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 07/04/2013
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Provider Practice Location Address
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Address Line | 4123 UNIVERSITY BLVD S SUITE C
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4371
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Country | US
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Telephone | 904-704-7140
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Fax | 866-683-8679
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Provider Business Mailing Address
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Address Line | 4123 UNIVERSITY BLVD S STE C
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4320
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Country | US
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Telephone | 904-704-7140
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Fax | 888-655-4672
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHITRA V RAJPAL
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Credential | MD
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Telephone | 904-704-7140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME108505
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License Number State | FL
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