Provider Demographics
NPI:1730196833
Name:BALA, MASSARAT A (MD)
Entity type:Individual
Prefix:DR
First Name:MASSARAT
Middle Name:A
Last Name:BALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 N PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4761
Mailing Address - Country:US
Mailing Address - Phone:847-359-3400
Mailing Address - Fax:847-358-2770
Practice Address - Street 1:921 N PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4761
Practice Address - Country:US
Practice Address - Phone:847-359-3400
Practice Address - Fax:847-358-2770
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091372Medicaid
ILG47904Medicare UPIN