Provider Demographics
NPI:1598946527
Name:BALAA, ANAS (MD)
Entity Type:Individual
Prefix:
First Name:ANAS
Middle Name:
Last Name:BALAA
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 1:1920 GLEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3229
Mailing Address - Country:US
Mailing Address - Phone:419-333-3751
Mailing Address - Fax:419-333-6437
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-7555
Practice Address - Fax:419-479-2696
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-092883207RP1001X, 207RC0200X
MI4301103137207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBA4310451Medicare PIN