MEDICARE: DR. VIKRAM ADITYA BALA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4143	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518490069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKRAM ADITYA BALA DPM

Provider Business Mailing Address
First Line	:	6206 ATLANTIC BLVD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-7560
Country	:	US
Telephone Number	:	904-731-3131
Fax Number	:	904-731-0209

Provider Business Practice Location Address
First Line	:	1760 EDGEWOOD AVE W # 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-7209
Country	:	US
Telephone Number	:	904-731-3131
Fax Number	:	904-731-0209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/15/2026

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