Provider Demographics
NPI:1669452561
Name:BALFANZ, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BALFANZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ESSENTIA HEALTH DULUTH CLINIC - MCL2CRED
Mailing Address - Street 2:400 EAST THIRD STREET
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8319
Mailing Address - Fax:
Practice Address - Street 1:233 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-227-7806
Practice Address - Fax:651-256-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2016-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN20262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN048087800Medicaid
F28474Medicare UPIN