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NPI Code Detail

MEDICARE: DR. RANDY DEWAIN BALMFORTH D.O.

MEDICARE: DR. RANDY DEWAIN BALMFORTH D.O.
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
12085R0202XDiagnostic Radiology Physician5101017227MI
22085R0202XDiagnostic Radiology Physician036132515IL
32085R0202XDiagnostic Radiology Physician2017018162MO

General Provider Information

NPI Number : 1366642738
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY DEWAIN BALMFORTH D.O.
Provider Business Mailing Address
First Line : 6245 INKSTER RD
Second Line :
City : GARDEN CITY
State : MI
Zip : 48135-4001
Country : US
Telephone Number : 734-421-3300
Fax Number :
Provider Business Practice Location Address
First Line : GARDEN CITY HOSPITAL
Second Line : 6245 INKSTER ROAD
City : GARDEN CITY
State : MI
Zip : 48135-4001
Country : US
Telephone Number : 734-421-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2007
Last Update Date : 03/02/2026

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