Provider Demographics
NPI:1366642738
Name:BALMFORTH, RANDY DEWAIN (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:DEWAIN
Last Name:BALMFORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:GARDEN CITY HOPITAL
Mailing Address - Street 2:6245 INKSTER ROAD
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4001
Mailing Address - Country:US
Mailing Address - Phone:734-421-3300
Mailing Address - Fax:
Practice Address - Street 1:GARDEN CITY HOSPITAL
Practice Address - Street 2:6245 INKSTER ROAD
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4001
Practice Address - Country:US
Practice Address - Phone:734-421-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010172272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology