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NPI Code Detail

MEDICARE: ROJA BALAKRISHNAN M.D.

MEDICARE: ROJA BALAKRISHNAN M.D.
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
1207R00000XInternal Medicine PhysicianMD104074MO

General Provider Information

NPI Number : 1588613111
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROJA BALAKRISHNAN M.D.
Provider Business Mailing Address
First Line : 620 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1926
Country : US
Telephone Number : 573-265-0448
Fax Number :
Provider Business Practice Location Address
First Line : 620 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1926
Country : US
Telephone Number : 573-265-0448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/08/2007

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