Provider Demographics
NPI:1730643552
Name:BALANCE INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:BALANCE INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYAS
Authorized Official - Middle Name:AMBEYAH
Authorized Official - Last Name:HAMID
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-667-5882
Mailing Address - Street 1:1007 NORTH FEDERAL HIGHWAY #9018
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304
Mailing Address - Country:US
Mailing Address - Phone:954-667-5882
Mailing Address - Fax:
Practice Address - Street 1:4952 SW 38TH WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312
Practice Address - Country:US
Practice Address - Phone:954-667-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty