Provider Demographics
NPI:1134106370
Name:BALKANY, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:BALKANY
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 1:6110 DOUBLE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-8718
Mailing Address - Country:US
Mailing Address - Phone:141-467-1012
Mailing Address - Fax:
Practice Address - Street 1:6110 DOUBLE EAGLE CT
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43566-8718
Practice Address - Country:US
Practice Address - Phone:419-344-2317
Practice Address - Fax:419-382-9427
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0296142086S0129X
OH0339592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0201721Medicaid
MI4308792Medicaid
OH0201721Medicaid
A75197Medicare UPIN
MI04600870Medicare ID - Type Unspecified