Provider Demographics
NPI:1023377645
Name:BALYSH, ERICA NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:BALYSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:27450 SCHOENHERR RD
Mailing Address - Street 2:STE. 400
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6683
Mailing Address - Country:US
Mailing Address - Phone:586-582-7550
Mailing Address - Fax:586-582-7515
Practice Address - Street 1:27450 SCHOENHERR RD
Practice Address - Street 2:STE. 400
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6683
Practice Address - Country:US
Practice Address - Phone:586-582-7550
Practice Address - Fax:586-582-7515
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine