Provider Demographics
NPI:1548640535
Name:BALOCH, TALHA JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:TALHA
Middle Name:JOHN
Last Name:BALOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8337 BALSAM LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7628
Mailing Address - Country:US
Mailing Address - Phone:708-325-8252
Mailing Address - Fax:708-325-8252
Practice Address - Street 1:7525 MITCHELL RD STE 315
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1958
Practice Address - Country:US
Practice Address - Phone:708-325-8252
Practice Address - Fax:708-294-8382
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361446242084P0800X, 2084P0802X
MN728462084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036144624Medicaid