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General NPI Number Information
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NPI Number | 1548640535
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Entity Type | Individual
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Provider Name | TALHA JOHN BALOCH MD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 7525 MITCHELL RD STE 315
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1958
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Country | US
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Telephone | 708-325-8252
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Fax | 708-294-8382
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Provider Business Mailing Address
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Address Line | 8337 BALSAM LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7628
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Country | US
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Telephone | 708-325-8252
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Fax | 708-325-8252
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036144624
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 036144624
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 72846
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License Number State | MN
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