Basic Information
| Provider Information | |||||||||
| NPI: | 1669441812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALUCH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E MAIN ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142223369 | ||||||||
| FaxNumber: | 6142241208 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E MAIN ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142223369 | ||||||||
| FaxNumber: | 6142241208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 35065452B | OH | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 3115821773A11 | 01 | ANTHEM | OTHER | 4330118 | 01 | AETNA PPO | OTHER | 19109 | 01 | COLUMBUS CCOP NUMBER | OTHER | 4221 | 01 | NATIONWIDE HEALTH PLANS | OTHER | 961814 | 01 | AETNA HMO | OTHER | BB3723308 | 01 | DEA | OTHER | 16724 | 01 | AM ASSOC OF CLINICAL UROL | OTHER | 311582177001 | 01 | CIGNA | OTHER | 315649 | 01 | AUA PERSONAL ID NUMBER | OTHER | 04112840112 | 01 | MEDICAL ED NUMBER | OTHER | 190073 | 01 | AM ASSOC OF CLINICAL UROL | OTHER | 0931657 | 05 | OH | MEDICAID | 22746 | 01 | NCI INVESTIGATORS NUMBER | OTHER |