Provider Demographics
NPI:1073741625
Name:BALASH, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:BALASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W 95TH ST STE 413
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2662
Mailing Address - Country:US
Mailing Address - Phone:708-346-4055
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 413
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2662
Practice Address - Country:US
Practice Address - Phone:708-346-4055
Practice Address - Fax:708-499-0948
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036129228208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery