MEDICARE: DR. PHILLIP BALK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	MD027077L	PA

General Provider Information

NPI Number	:	1306087291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP BALK M.D.

Provider Business Mailing Address
First Line	:	116 OAK PARK PL
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1146
Country	:	US
Telephone Number	:	412-531-5020
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 OAK PARK PL
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1146
Country	:	US
Telephone Number	:	412-531-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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