Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 97901875 | FL |
NPI | 1174504898 |
---|---|
Provider Name | Balagangadhar Rao Totapally |
First Address | Miami, FL 33155-3009 |
Second Address | Miami, FL 33155-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04492 | (02) | |
49266 | BCBS (01) | FL |