Provider Demographics
NPI:1578552386
Name:BALOG, NATALI M (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALI
Middle Name:M
Last Name:BALOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:6901 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8022
Practice Address - Country:US
Practice Address - Phone:574-647-4500
Practice Address - Fax:574-647-6354
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060398A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200528210Medicaid
IN236040320OtherMEDICARE PTAN
INI40171Medicare UPIN