MEDICARE: ALAN L BALKANSKY DPMSC

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
1	213E00000X	Podiatrist	429025	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0864550001	OTHER		MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326124694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN L BALKANSKY DPMSC

Provider Business Mailing Address
First Line	:	5404A N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-442-3400
Fax Number	:	414-442-0344

Provider Business Practice Location Address
First Line	:	5404A N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-442-3400
Fax Number	:	414-442-0344

Authorized Official
Title or Position	:	PRESIDENT PODIATRIST
Name	:	DR. ALAN L BALKANSKY
Credential	:	DPM
Telephone Number	:	414-442-3400

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	11/20/2012

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