Individual
BALAJI NITHIANANDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017
(859) 572-3617
(859) 572-2326
Mailing address
PO BOX 18667, ERLANGER, KY 41018-0667
(513) 638-0593
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
51465
KY
Other
Enumeration date
05/11/2015
Last updated
07/31/2018
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