Basic Information
| Provider Information | |||||||||
| NPI: | 1659399822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALOCH | ||||||||
| FirstName: | IMRAN | ||||||||
| MiddleName: | AHMED | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19070 | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543079070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204964700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 N COMMERCIAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | NEENAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549562619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208860818 | ||||||||
| FaxNumber: | 9208860773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 10/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-115581 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 67433-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.