Healthcare Provider Details

I. General information

NPI: 1134106370
Provider Name (Legal Business Name): LOUIS BALKANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 DOUBLE EAGLE CT
WATERVILLE OH
43566-8718
US

IV. Provider business mailing address

6110 DOUBLE EAGLE CT
WATERVILLE OH
43566-8718
US

V. Phone/Fax

Practice location:
  • Phone: 419-344-2317
  • Fax: 419-382-9427
Mailing address:
  • Phone: 141-467-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number029614
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number033959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: