Provider Demographics
NPI:1942722426
Name:BALA, ABISHEK
Entity Type:Individual
Prefix:
First Name:ABISHEK
Middle Name:
Last Name:BALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:
Practice Address - Street 1:3201 HALLMARK CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2109
Practice Address - Country:US
Practice Address - Phone:989-746-7500
Practice Address - Fax:989-746-7658
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011123042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry