Individual
DR. PRAVEEN CHANDAR BALRAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21321 E OCOTILLO RD STE 125, QUEEN CREEK, AZ 85142-5995
(480) 936-7722
(480) 936-7723
Mailing address
2040 S ALMA SCHOOL RD STE 1, CHANDLER, AZ 85286-7076
(480) 936-7722
(480) 936-7723
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MT191085
PA
2086S0129X
Vascular Surgery Physician
4301103519
MI
2086S0129X
Vascular Surgery Physician
Primary
55078
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
316871
—
AZ
Enumeration date
07/06/2010
Last updated
07/22/2021
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