MEDICARE: DR. TALHA JOHN BALOCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036144624	IL
2	2084P0802X	Addiction Psychiatry Physician	036144624	IL
3	2084P0802X	Addiction Psychiatry Physician	72846	MN

General Provider Information

NPI Number	:	1548640535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TALHA JOHN BALOCH MD

Provider Business Mailing Address
First Line	:	8337 BALSAM LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-7628
Country	:	US
Telephone Number	:	708-325-8252
Fax Number	:	708-325-8252

Provider Business Practice Location Address
First Line	:	7525 MITCHELL RD STE 315
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-1958
Country	:	US
Telephone Number	:	708-325-8252
Fax Number	:	708-294-8382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	11/29/2024

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