Provider Demographics
NPI:1245409184
Name:BALK, SAMUEL K (PA)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:K
Last Name:BALK
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Gender:M
Credentials:PA
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Mailing Address - Street 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-734-4110
Mailing Address - Fax:402-734-3990
Practice Address - Street 1:4229 N 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4136
Practice Address - Country:US
Practice Address - Phone:402-401-6000
Practice Address - Fax:402-401-6015
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2016-02-05
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Provider Licenses
StateLicense IDTaxonomies
NE1015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant