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General NPI Number Information
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NPI Number | 1174625065
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Entity Type | Organization
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Legal Business Name | BALTES CARDIOLOGY
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 821 BROADWAY
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City | FORT WAYNE
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State | IN
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Zip | 46802-2107
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Country | US
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Telephone | 260-439-0044
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Fax | 260-422-7860
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Provider Business Mailing Address
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Address Line | 821 BROADWAY
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City | FORT WAYNE
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State | IN
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Zip | 46802-2107
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Country | US
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Telephone | 260-439-0044
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Fax | 260-422-7860
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | WM EDWARD BALTES
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Credential | MD
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Telephone | 260-439-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 01026188A
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License Number State | IN
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