Provider Demographics
NPI:1770825283
Name:KRISHNAIAH, BALAJI (M D,)
Entity type:Individual
Prefix:DR
First Name:BALAJI
Middle Name:
Last Name:KRISHNAIAH
Suffix:
Gender:M
Credentials:M D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 EASTMORELAND AVE STE 370
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7542
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-758-7888
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN571442084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036065Medicaid
MO1770825283Medicaid