Healthcare Provider Details

I. General information

NPI: 1730101452
Provider Name (Legal Business Name): ANGELA N BALANON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA N BRANIECKI P.A.

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33200 W 14 MILE RD STE 220
WEST BLOOMFIELD MI
48322-3586
US

IV. Provider business mailing address

26211 CENTRAL PARK BLVD STE 201
SOUTHFIELD MI
48076-4158
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-7400
  • Fax: 248-626-6481
Mailing address:
  • Phone: 833-667-3627
  • Fax: 248-327-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601994644
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: