Provider Demographics
NPI:1790393692
Name:MACHANAHALLI BALAKRISHNA, AKSHAY (MBBS)
Entity Type:Individual
Prefix:MR
First Name:AKSHAY
Middle Name:
Last Name:MACHANAHALLI BALAKRISHNA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY ROAD, SUITE 202 - CU DEPARTMENT OF INTERNAL
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2353
Mailing Address - Country:US
Mailing Address - Phone:402-280-4392
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY ROAD, SUITE 202 - CU DEPARTMENT OF INTERNAL
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2353
Practice Address - Country:US
Practice Address - Phone:402-280-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8908390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program