Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 029614 | MI |
Y | 2086S0129X | Vascular Surgeon | 033959 | OH |
NPI | 1134106370 |
---|---|
Provider Name | Dr. Louis Balkany |
First Address | Toledo, OH 43614-3464 |
Second Address | Toledo, OH 43614-3464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 19/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0201721 | (05) | OH |
4308792 | (05) | MI |
A75197 | (02) |