Healthcare Provider Details

I. General information

NPI: 1790394039
Provider Name (Legal Business Name): MUHAMMAD YASIR BALOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL, DIV IM NEPHROLOGY, STE 5C
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

900 RIGGINS RD APT 738
TALLAHASSEE FL
32308-2221
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7603
  • Fax: 314-747-5213
Mailing address:
  • Phone: 850-688-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024048325
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2024048325
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: