Provider Demographics
NPI:1174625065
Name:BALTES CARDIOLOGY
Entity type:Organization
Organization Name:BALTES CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BALTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-439-0044
Mailing Address - Street 1:821 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2107
Mailing Address - Country:US
Mailing Address - Phone:260-439-0044
Mailing Address - Fax:260-422-7860
Practice Address - Street 1:821 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2107
Practice Address - Country:US
Practice Address - Phone:260-439-0044
Practice Address - Fax:260-422-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026188A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100330950Medicaid
IN295429889004OtherBCBS TPR
IN000000090931OtherANTHEM TPR
IN100059740AMedicaid
IN303562034003OtherBCBS
IN100460500Medicaid
IN000000090932OtherWEB ANTHEM
IN295429889004OtherBCBS TPR
IN667580AMedicare ID - Type UnspecifiedWEB ANGOLA
IN100059740AMedicaid
IN100330950Medicaid
INE21659Medicare UPIN
IN66 7570BMedicare ID - Type UnspecifiedTPR MC FW
IN667570AMedicare ID - Type UnspecifiedWEB FORT WAYNE