Provider Demographics
NPI:1386824167
Name:BALIC, IVANA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVANA
Middle Name:
Last Name:BALIC
Suffix:
Gender:F
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:PO BOX 4036
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1303
Mailing Address - Country:US
Mailing Address - Phone:614-569-9496
Mailing Address - Fax:
Practice Address - Street 1:7625 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9649
Practice Address - Country:US
Practice Address - Phone:614-717-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN19902084P0800X
OH35.1244742084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid
TX282771901Medicaid
OH0112766Medicaid
TX282771901Medicaid