Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019029606 | IL |
Y | 213EG0000X | General Practice | 019029606 | IL |
NPI | 1003240540 |
---|---|
Provider Name | Dr. Christopher V Balda |
First Address | Effingham, IL 62401-4479 |
Second Address | Effingham, IL 62401-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2013 |
Last Update Date | 31/08/2013 |