Provider Demographics
NPI:1811965304
Name:BALMAKUND, JHABLALL (MD)
Entity type:Individual
Prefix:
First Name:JHABLALL
Middle Name:
Last Name:BALMAKUND
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 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 207
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2236
Practice Address - Country:US
Practice Address - Phone:561-482-1027
Practice Address - Fax:561-482-1028
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME846472084N0402X, 2084N0402X
ARE56242084N0402X
ND170162084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102768500Medicaid
MN130000649Medicare ID - Type Unspecified
MN088323900Medicaid
AR5AG63Medicare PIN