MEDICARE: ALAN L BALKANSKY DPM

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	213ES0131X	Foot Surgery Podiatrist	429-025	WI

General Provider Information

NPI Number	:	1871786590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN L BALKANSKY DPM

Provider Business Mailing Address
First Line	:	5404A N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-442-3400
Fax Number	:	414-442-0344

Provider Business Practice Location Address
First Line	:	5404A N LOVERS LANE RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-3006
Country	:	US
Telephone Number	:	414-442-3400
Fax Number	:	414-442-0344

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	11/04/2010

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