Healthcare Provider Details

I. General information

NPI: 1114979366
Provider Name (Legal Business Name): ADAM H BALIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N MAIN ST DEAN MEDICAL CENTER
OREGON WI
53575-1003
US

IV. Provider business mailing address

753 N MAIN ST DEAN MEDICAL CENTER
OREGON WI
53575-1003
US

V. Phone/Fax

Practice location:
  • Phone: 608-835-3156
  • Fax: 608-835-1010
Mailing address:
  • Phone: 608-835-3156
  • Fax: 608-835-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30273-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: