Healthcare Provider Details

I. General information

NPI: 1558719658
Provider Name (Legal Business Name): MICHAEL ISAM BALAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2016
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8575 PITNER RD
HOUSTON TX
77080-2010
US

IV. Provider business mailing address

5502 1ST ST
KATY TX
77493-2472
US

V. Phone/Fax

Practice location:
  • Phone: 713-462-6565
  • Fax:
Mailing address:
  • Phone: 713-462-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberS4441
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberS4441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: