Provider Demographics
NPI:1003270802
Name:A BALANCED LIFE MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:A BALANCED LIFE MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-883-9330
Mailing Address - Street 1:430 W EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2402
Mailing Address - Country:US
Mailing Address - Phone:309-525-5012
Mailing Address - Fax:
Practice Address - Street 1:430 W EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2402
Practice Address - Country:US
Practice Address - Phone:309-525-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074050208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty