Provider Demographics
NPI:1245983618
Name:BALANCE PODIATRY PLLC
Entity type:Organization
Organization Name:BALANCE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS-HAKIMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:832-899-4708
Mailing Address - Street 1:14502 CYPRESS MILL PLACE BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7299
Mailing Address - Country:US
Mailing Address - Phone:832-899-4708
Mailing Address - Fax:832-899-4709
Practice Address - Street 1:14502 CYPRESS MILL PLACE BLVD # 300
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-7299
Practice Address - Country:US
Practice Address - Phone:832-899-4708
Practice Address - Fax:832-899-4709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1245983618Medicaid
TX350336902Medicaid