Healthcare Provider Details

I. General information

NPI: 1447285655
Provider Name (Legal Business Name): THOMAS J BALFANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2099
US

IV. Provider business mailing address

8170 33RD AVE S MS 21110Q
BLOOMINGTON MN
55425
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax: 320-255-6327
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number33476
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: