Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 49717 | WI |
NPI | 1104926310 |
---|---|
Provider Name | Celestino P. Balinghasay |
First Address | Marshfield, WI 54449-5703 |
Second Address | Marshfield, WI 54449-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 06/03/2013 |