Healthcare Provider Details

I. General information

NPI: 1669452561
Provider Name (Legal Business Name): JOHN R BALFANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GRAND AVE
ST PAUL MN
55102
US

IV. Provider business mailing address

ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-7806
  • Fax: 651-256-6707
Mailing address:
  • Phone: 218-786-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20262
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: