Healthcare Provider Details

I. General information

NPI: 1942722426
Provider Name (Legal Business Name): ABISHEK BALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 SPICEBUSH DR
SAGINAW MI
48603-2468
US

IV. Provider business mailing address

4423 SPICEBUSH DR
SAGINAW MI
48603-2468
US

V. Phone/Fax

Practice location:
  • Phone: 989-332-5538
  • Fax:
Mailing address:
  • Phone: 989-332-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301507077
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301112304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: