MEDICARE: DR. RADHAKRISHNAN 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
1	207RN0300X	Nephrology Physician	34114	AZ

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	:	1851377139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADHAKRISHNAN BALAKRISHNAN M.D.

Provider Business Mailing Address
First Line	:	6622 N 91ST AVE
Second Line	:	STE 220
City	:	GLENDALE
State	:	AZ
Zip	:	85305-2569
Country	:	US
Telephone Number	:	602-759-6883
Fax Number	:	602-224-3358

Provider Business Practice Location Address
First Line	:	18699 N 67TH AVE
Second Line	:	SUITE 280
City	:	GLENDALE
State	:	AZ
Zip	:	85308-7140
Country	:	US
Telephone Number	:	623-240-4277
Fax Number	:	623-566-0263

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	06/26/2018

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