MEDICARE: DR. DAVID A BALT DO

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	207Q00000X	Family Medicine Physician	37593	MN
2	207Q00000X	Family Medicine Physician	1971	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457315038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A BALT DO

Provider Business Mailing Address
First Line	:	353 FAIRMONT BLVD
Second Line	:	ATTEN MEDICAL STAFF SERVICES
City	:	RAPID CITY
State	:	SD
Zip	:	57701-6000
Country	:	US
Telephone Number	:	605-719-7109
Fax Number	:	605-719-1027

Provider Business Practice Location Address
First Line	:	1440 N MAIN ST
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57783-1505
Country	:	US
Telephone Number	:	605-644-4004
Fax Number	:	605-644-4006

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/25/2012

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