Individual
MITHRA BALIGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1530
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1530
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
13699
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112563
—
MS
05
—
1398713
—
MS
01
—
220012684
RR MEDICARE
MS
01
—
P00641624
RR MEDICARE
MS
Enumeration date
06/17/2006
Last updated
07/08/2013
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