Provider Demographics
NPI:1326427105
Name:BALMASEDA, PAOLO NINO
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:NINO
Last Name:BALMASEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26750 PROVIDENCE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1212
Mailing Address - Country:US
Mailing Address - Phone:248-465-4782
Mailing Address - Fax:248-465-4852
Practice Address - Street 1:26750 PROVIDENCE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1212
Practice Address - Country:US
Practice Address - Phone:248-465-4782
Practice Address - Fax:248-465-4852
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301500673207QS0010X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program