Healthcare Provider Details

I. General information

NPI: 1659361053
Provider Name (Legal Business Name): CHRISTOPHER KIM BALKANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 13TH ST S.
ST CLOUD MN
56301
US

IV. Provider business mailing address

2008 13TH ST S.
ST CLOUD MN
56301
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4449
  • Fax:
Mailing address:
  • Phone: 320-259-4449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number37289
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: