Provider Demographics
NPI:1710929187
Name:BALIGA, RADHAKRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:RADHAKRISHNA
Middle Name:
Last Name:BALIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1315 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2406
Practice Address - Country:US
Practice Address - Phone:504-842-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS136892080P0210X
LAMD.05179R2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112700Medicaid
LA1305723Medicaid
MS370000315Medicare ID - Type UnspecifiedMISSISSIPPI MEDICARE
LA302443YH3UMedicare PIN
MS00112700Medicaid
MS512I370021Medicare PIN
MS302I377218Medicare PIN