MEDICARE: ALAN L BALKANSKY DPM SC

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	261QP1100X	Podiatric Clinic/Center	429025	WI

General Provider Information

NPI Number	:	1659569705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN L BALKANSKY DPM SC

Provider Business Mailing Address
First Line	:	101 FALLS RD
Second Line	:	SUITE 600
City	:	GRAFTON
State	:	WI
Zip	:	53024-2612
Country	:	US
Telephone Number	:	262-375-1940
Fax Number	:	262-375-0534

Provider Business Practice Location Address
First Line	:	101 FALLS RD
Second Line	:	SUITE 600
City	:	GRAFTON
State	:	WI
Zip	:	53024-2612
Country	:	US
Telephone Number	:	262-375-1940
Fax Number	:	262-375-0534

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN L. BALKANSKY
Credential	:	DPM SC
Telephone Number	:	262-375-1940

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	12/22/2011

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