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NPI Code Detail

MEDICARE: KIM A BALOGH PA

MEDICARE: KIM A BALOGH PA
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
1363AM0700XMedical Physician AssistantPA0002878FL

General Provider Information

NPI Number : 1487641387
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM A BALOGH PA
Provider Business Mailing Address
First Line : 500 WINDERLEY PL
Second Line : SUITE 115
City : MAITLAND
State : FL
Zip : 32751-7247
Country : US
Telephone Number : 407-875-8784
Fax Number :
Provider Business Practice Location Address
First Line : 601 E ROLLINS ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-1248
Country : US
Telephone Number : 407-303-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 07/08/2007

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Directions to “ KIM A BALOGH PA” Practice Location

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