Provider Demographics
NPI:1114979366
Name:BALIN, ADAM H (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:H
Last Name:BALIN
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 1:753 N MAIN ST
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1003
Mailing Address - Country:US
Mailing Address - Phone:608-835-3156
Mailing Address - Fax:608-835-1010
Practice Address - Street 1:753 N MAIN ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1003
Practice Address - Country:US
Practice Address - Phone:608-835-3156
Practice Address - Fax:608-835-1010
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30273-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114979366Medicaid
WI31537500Medicaid
E53285Medicare UPIN
WI31537500Medicaid
WI080048440Medicare PIN