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General NPI Number Information
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NPI Number | 1952495970
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Entity Type | Individual
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Provider Name | DALE A BALKOVEC DO
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 15003 TURNEY RD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-4730
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Country | US
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Telephone | 216-663-7753
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Fax | 216-663-0897
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Provider Business Mailing Address
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Address Line | 15003 TURNEY ROAD
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137
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Country | US
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Telephone | 216-663-7753
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Fax | 216-663-0897
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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 | 34003692
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License Number State | OH
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