Provider Demographics
NPI:1659569705
Name:ALAN L BALKANSKY DPM SC
Entity Type:Organization
Organization Name:ALAN L BALKANSKY DPM SC
Other - Org Name:GRAFTON PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALKANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM SC
Authorized Official - Phone:262-375-1940
Mailing Address - Street 1:101 FALLS RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2612
Mailing Address - Country:US
Mailing Address - Phone:262-375-1940
Mailing Address - Fax:262-375-0534
Practice Address - Street 1:101 FALLS RD
Practice Address - Street 2:SUITE 600
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2612
Practice Address - Country:US
Practice Address - Phone:262-375-1940
Practice Address - Fax:262-375-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI429025261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000086695Medicare PIN