Dr. Kethandapatti Chakravarthy Balaji, MBBS
Urology in Jacksonville, FL. Individual provider (NPI-1).
NPI number1558314484
StatusActive
Last updated in NPPESNov 14, 2018
Details
- NPI
- 1558314484
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kethandapatti Chakravarthy Balaji
- Credential
- MBBS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 19, 2006
- Last updated
- Nov 14, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208800000X | Urology | ME137242 | FL | Yes |
| 208800000X | Urology | 2010-01458 | NC |
Practice location
655 W 8th StJacksonville, FL 32209-6511
Phone 904-383-1016
Mailing address
Po Box 44008Jacksonville, FL 32231-4008
Phone 904-383-1016
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