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1346205788 NPI number — MITZI M BALES MD

NPI Number: 1346205788
Health Care Provider/Practitioner: MITZI M BALES MD

Information about “1346205788” NPI (MITZI M BALES MD) exists in 1346205788 in HTML format HTML  |  1346205788 in plain Text format TXT  |  1346205788 in PDF (Portable Document Format) PDF  |  1346205788 in an XML format XML  formats.

NPI Number : 1346205788 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346205788",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BALES",
    "FirstName": "MITZI",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BALES",
    "OtherFirstName": "MITZI",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2117 KEYSTONE CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANDOVER",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67002-8749",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-733-5120",
    "MailingAddressFaxNumber": "316-733-1280",
    "FirstLinePracticeLocationAddress": "2117 KEYSTONE CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ANDOVER",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "67002-8749",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "316-733-5120",
    "PracticeLocationAddressFaxNumber": "316-733-1280",
    "EnumerationDate": "04/19/2006",
    "LastUpdateDate": "05/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "04-26016",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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