MEDICARE: BALANCED INNOVATIVE CARE LLC

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
2	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1902543309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED INNOVATIVE CARE LLC

Provider Business Mailing Address
First Line	:	5950 MAYFIELD RD # 1119
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2905
Country	:	US
Telephone Number	:	614-602-2172
Fax Number	:	614-705-0025

Provider Business Practice Location Address
First Line	:	3737 EASTON MARKET STE 1067
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-6023
Country	:	US
Telephone Number	:	614-602-2172
Fax Number	:	614-705-0025

Authorized Official
Title or Position	:	OWNER AND PSYCHIATRIST
Name	:	DR. VEENA TRIPATHI AHUJA
Credential	:	MD
Telephone Number	:	614-602-2172

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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