Provider Demographics
NPI:1326124694
Name:ALAN L BALKANSKY DPMSC
Entity Type:Organization
Organization Name:ALAN L BALKANSKY DPMSC
Other - Org Name:HEALTHY FOOT & ANKLE GRAFTON PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALKANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-442-3400
Mailing Address - Street 1:5404A N LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3006
Mailing Address - Country:US
Mailing Address - Phone:414-442-3400
Mailing Address - Fax:414-442-0344
Practice Address - Street 1:5404A N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:414-442-3400
Practice Address - Fax:414-442-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI429025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0864550001OtherMEDICARE NSC
WI43210400Medicaid
T61407Medicare UPIN
81339Medicare ID - Type Unspecified