Provider Demographics
NPI:1043210388
Name:SANDROCK, BALZER C (MD)
Entity Type:Individual
Prefix:
First Name:BALZER
Middle Name:C
Last Name:SANDROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8185 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9335
Mailing Address - Country:US
Mailing Address - Phone:513-398-7171
Mailing Address - Fax:513-398-8683
Practice Address - Street 1:8185 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9335
Practice Address - Country:US
Practice Address - Phone:513-398-7171
Practice Address - Fax:513-398-8683
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0941762Medicaid