Provider Demographics
NPI:1467799577
Name:SHRI BALAJI MEDICAL SERVICES
Entity Type:Organization
Organization Name:SHRI BALAJI MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAJPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-704-7140
Mailing Address - Street 1:4123 UNIVERSITY BLVD S STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4320
Mailing Address - Country:US
Mailing Address - Phone:904-704-7140
Mailing Address - Fax:888-655-4672
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4371
Practice Address - Country:US
Practice Address - Phone:904-704-7140
Practice Address - Fax:866-683-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty