Basic Information
| Provider Information | |||||||||
| NPI: | 1760461073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALWALLY | ||||||||
| FirstName: | ATUL | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 S PATTERSON BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454022684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962600 | ||||||||
| FaxNumber: | 9374962610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1222 S PATTERSON BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454022684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962600 | ||||||||
| FaxNumber: | 9374962610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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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 | 207Y00000X | 35070075 | OH | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1000362 | 01 | MEDICARE COMPLETE | OTHER | 040016607 | 01 | MEDICARE RAILROAD | OTHER | 1000362 | 01 | UNITED HEALTH CARE | OTHER | 0254148 | 01 | OHIO DEPT OF HEALTH & HUM | OTHER | 2597293 | 01 | AETNA | OTHER | 000000209357 | 01 | ANTHEM | OTHER | 0254148 | 01 | BCMH | OTHER |