Healthcare Provider Details

I. General information

NPI: 1255313540
Provider Name (Legal Business Name): AMY C BALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE SUITE 400
HOBART IN
46342-6790
US

IV. Provider business mailing address

1400 S LAKE PARK AVE SUITE 400
HOBART IN
46342-6790
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-6166
  • Fax: 219-942-4106
Mailing address:
  • Phone: 219-942-6166
  • Fax: 219-942-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01053920A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: