Provider Demographics
NPI:1932103264
Name:BALIGA, RAJENDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:S
Last Name:BALIGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12662 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0935
Mailing Address - Country:US
Mailing Address - Phone:813-910-8708
Mailing Address - Fax:855-852-7153
Practice Address - Street 1:4710 N HABANA AVE STE 107
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7143
Practice Address - Country:US
Practice Address - Phone:813-910-8708
Practice Address - Fax:855-852-7153
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82461207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269733500Medicaid
FLH38586Medicare UPIN
FL269733500Medicaid