Provider Demographics
NPI:1922237593
Name:BALKI, AMRO (MD)
Entity Type:Individual
Prefix:
First Name:AMRO
Middle Name:
Last Name:BALKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMRO
Other - Middle Name:
Other - Last Name:ELBALKHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2336 SANTA MONICA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2067
Mailing Address - Country:US
Mailing Address - Phone:310-449-1999
Mailing Address - Fax:310-453-8533
Practice Address - Street 1:2336 SANTA MONICA BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2067
Practice Address - Country:US
Practice Address - Phone:310-449-1999
Practice Address - Fax:310-453-8533
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA129471207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program