Provider Demographics
NPI:1477532943
Name:BALMADRID, LUZ L (MD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:L
Last Name:BALMADRID
Suffix:
Gender:F
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:107 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1002
Practice Address - Country:US
Practice Address - Phone:920-846-3092
Practice Address - Fax:920-846-8313
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33603-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326349135OtherCMH SB NPI
WI1851477913OtherCMH NPI
WI1467583096OtherCMH PCC OF NPI
WI31872600Medicaid
WI521Z310Medicare Oscar/Certification
WI31872600Medicaid
WI1326349135OtherCMH SB NPI
WIK400292644Medicare Oscar/Certification
F38740Medicare UPIN
WIK400292505Medicare Oscar/Certification