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NPI Code Detail

MEDICARE: RICHARD BALON MD

MEDICARE:   RICHARD  BALON  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician4301047336MI

General Provider Information

NPI Number : 1134166846
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD BALON MD
Provider Business Mailing Address
First Line : 1560 E MAPLE RD
Second Line : SUITE 400-CREDENTIALING
City : TROY
State : MI
Zip : 48083-1138
Country : US
Telephone Number : 313-993-3434
Fax Number : 313-993-3421
Provider Business Practice Location Address
First Line : 3901 WALTER P CHRYSLER SERVICE DR.
Second Line :
City : DETROIT
State : MI
Zip : 48201-2167
Country : US
Telephone Number : 313-993-3434
Fax Number : 313-993-3421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 11/16/2015

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Directions to “ RICHARD BALON MD” Practice Location

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