Provider Demographics
NPI:1497765895
Name:BALZANO, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:BALZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:200 HEALTHCARE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3226
Practice Address - Country:US
Practice Address - Phone:941-261-0160
Practice Address - Fax:941-261-0165
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94261207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4374189OtherAETNA
FL8078334OtherCIGNA
FL0415848OtherUNITED HEALTHCARE
FL312666OtherAVMED
FL34010OtherBLUE CROSS BLUE SHIELD
FLP00280220OtherRAILROAD MEDICARE
FL8078334OtherCIGNA
FL34010ZMedicare ID - Type Unspecified