Provider Demographics
NPI:1568254209
Name:BALOUCH, ISHA AHMED (N/A)
Entity type:Individual
Prefix:
First Name:ISHA
Middle Name:AHMED
Last Name:BALOUCH
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:ISHA
Other - Middle Name:AHMED
Other - Last Name:BALOUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:N/A
Mailing Address - Street 1:3929 PIMLICO DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6521
Mailing Address - Country:US
Mailing Address - Phone:405-837-8044
Mailing Address - Fax:
Practice Address - Street 1:1111 W 17TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-1886
Practice Address - Country:US
Practice Address - Phone:918-582-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program