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General NPI Number Information
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NPI Number | 1346205788
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Entity Type | Individual
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Provider Name | MITZI M BALES MD
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 2117 KEYSTONE CIR
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City | ANDOVER
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State | KS
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Zip | 67002-8749
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Country | US
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Telephone | 316-733-5120
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Fax | 316-733-1280
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Provider Business Mailing Address
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Address Line | 2117 KEYSTONE CIR
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City | ANDOVER
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State | KS
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Zip | 67002-8749
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Country | US
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Telephone | 316-733-5120
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Fax | 316-733-1280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-26016
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License Number State | KS
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