Provider Demographics
NPI:1205820024
Name:BALK, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:BALK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 880
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-256-2525
Mailing Address - Fax:404-845-4730
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 880
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-256-2525
Practice Address - Fax:404-845-4730
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2018-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034533207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000477782DMedicaid
GA11BDPXWMedicare ID - Type Unspecified