Provider Demographics
NPI:1952740318
Name:BALAMOHAN, SANJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:BALAMOHAN
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 1:1875 DEMPSTER ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1127
Mailing Address - Country:US
Mailing Address - Phone:847-685-1000
Mailing Address - Fax:847-685-6685
Practice Address - Street 1:1875 DEMPSTER ST STE 301
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1127
Practice Address - Country:US
Practice Address - Phone:847-685-1000
Practice Address - Fax:847-685-6685
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INTRN19036207Y00000X
IL036145758207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology