Provider Demographics
NPI:1235343906
Name:BALOCH, SAIRA IMTIAZ (MD)
Entity Type:Individual
Prefix:
First Name:SAIRA
Middle Name:IMTIAZ
Last Name:BALOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAIRA
Other - Middle Name:
Other - Last Name:IMTIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1402 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N STE 2210
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6124
Practice Address - Country:US
Practice Address - Phone:972-747-4325
Practice Address - Fax:972-747-4324
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine