Provider Demographics
NPI:1104831536
Name:BALUCH, MEHDI H (MD)
Entity type:Individual
Prefix:
First Name:MEHDI
Middle Name:H
Last Name:BALUCH
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 1:900 COOPER AVE STE 4300
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5182
Mailing Address - Country:US
Mailing Address - Phone:989-583-7460
Mailing Address - Fax:989-583-7432
Practice Address - Street 1:900 COOPER AVE STE 4300
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-7460
Practice Address - Fax:989-583-7432
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072702207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01006013OtherHEALTHPLUS
MI4950780Medicaid
MI17991OtherMCARE
MI4944577Medicaid
MI700D410040OtherBCBSM
MI1022523OtherMCLAREN HEALTH PLAN
MI1022523OtherMHP MHA
MIP38420001Medicare ID - Type Unspecified
MI4950780Medicaid
MI17991OtherMCARE
MI1022523OtherMHP MHA