MEDICARE: JOHN BALKO 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
1	231H00000X	Audiologist	SL001837L	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1932104742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BALKO MD

Provider Business Mailing Address
First Line	:	102 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	866-758-4862
Fax Number	:	330-758-4886

Provider Business Practice Location Address
First Line	:	102 N KEEL RIDGE RD
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-3440
Country	:	US
Telephone Number	:	866-758-4862
Fax Number	:	330-758-4886

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	01/29/2013

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