Provider Demographics
NPI:1447131636
Name:BALCHA, MENGISTU GURMU (MD)
Entity type:Individual
Prefix:DR
First Name:MENGISTU
Middle Name:GURMU
Last Name:BALCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5264 ISLAND CHAIN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1364
Mailing Address - Country:US
Mailing Address - Phone:725-294-6931
Mailing Address - Fax:
Practice Address - Street 1:917 PACIFIC AVE STE 600
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4437
Practice Address - Country:US
Practice Address - Phone:253-232-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML70047995207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine