Provider Demographics
NPI:1386661015
Name:BALAREZO, ALFREDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:BALAREZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20600 EUREKA RD
Mailing Address - Street 2:STE 801
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180
Mailing Address - Country:US
Mailing Address - Phone:734-285-7880
Mailing Address - Fax:734-285-2020
Practice Address - Street 1:20600 EUREKA RD
Practice Address - Street 2:STE 801
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:734-285-7880
Practice Address - Fax:734-285-2020
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAB034772207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2732271Medicaid
MI2732271Medicaid
E21192Medicare UPIN