Provider Demographics
NPI:1528023793
Name:BALDING, MARSHALL GEORGE (DPM)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:GEORGE
Last Name:BALDING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4186
Mailing Address - Country:US
Mailing Address - Phone:630-896-5005
Mailing Address - Fax:630-896-5087
Practice Address - Street 1:356 N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4186
Practice Address - Country:US
Practice Address - Phone:630-896-5005
Practice Address - Fax:630-896-5087
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0455090002OtherDME
ILT35532Medicare UPIN
IL0455090002OtherDME