Provider Demographics
NPI:1346394715
Name:BALUCHI MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:BALUCHI MEDICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-932-8000
Mailing Address - Street 1:1 S. 161 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-932-8000
Mailing Address - Fax:
Practice Address - Street 1:1S161 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3904
Practice Address - Country:US
Practice Address - Phone:630-932-8000
Practice Address - Fax:630-932-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606805OtherBCBS PROVIDER ID
ILCJ5711OtherRAILROAD MEDICARE
IL21606805OtherBCBS PROVIDER ID
ILCJ5711Medicare PIN
IL338780Medicare PIN