Provider Demographics
NPI:1104831536
Name:BALUCH, MEHDI H (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:H
Last Name:BALUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8172 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:586-710-8300
Mailing Address - Fax:
Practice Address - Street 1:3100 CROSS CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2775
Practice Address - Country:US
Practice Address - Phone:248-484-4300
Practice Address - Fax:248-475-9376
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072702207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01006013OtherHEALTHPLUS
MI1022523OtherMCLAREN HEALTH PLAN
MI700D410040OtherBCBSM
MI1022523OtherMHP MHA
MI17991OtherMCARE
MI4944577Medicaid
MI4950780Medicaid
MIP38420001Medicare ID - Type Unspecified
MI4950780Medicaid
MI17991OtherMCARE
MI1022523OtherMHP MHA