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General NPI Number Information
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NPI Number | 1568450385
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Entity Type | Organization
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Legal Business Name | BAY PEDIATRIC CARDIOLOGY INC
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 2727 W MARTIN LUTHER KING BLVD SUITE 620
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City | TAMPA
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State | FL
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Zip | 33607
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Country | US
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Telephone | 813-890-8004
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Fax | 813-290-9691
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Provider Business Mailing Address
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Address Line | 2727 W MARTIN LUTHER KING BLVD SUITE 620
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City | TAMPA
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State | FL
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Zip | 33607
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Country | US
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Telephone | 813-890-8004
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Fax | 813-290-9691
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. NATRAJ BALLAL
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Credential | M.D.
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Telephone | 813-890-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0069549
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License Number State | FL
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