MEDICARE: DR. KATHRYN VANCKO BALAZS D.O.

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	207N00000X	Dermatology Physician	34006753B	OH

General Provider Information

NPI Number	:	1669472650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN VANCKO BALAZS D.O.

Provider Business Mailing Address
First Line	:	3572 DAYTON XENIA RD
Second Line	:	SUITE 105
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2886
Country	:	US
Telephone Number	:	937-427-4600
Fax Number	:	937-427-4520

Provider Business Practice Location Address
First Line	:	3572 DAYTON XENIA RD
Second Line	:	SUITE 105
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2886
Country	:	US
Telephone Number	:	937-427-4600
Fax Number	:	937-427-4520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	06/08/2017

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