Provider Demographics
NPI:1669472650
Name:BALAZS, KATHRYN VANCKO (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:VANCKO
Last Name:BALAZS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3572 DAYTON XENIA RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2886
Mailing Address - Country:US
Mailing Address - Phone:937-427-4600
Mailing Address - Fax:937-427-4520
Practice Address - Street 1:3572 DAYTON XENIA RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2886
Practice Address - Country:US
Practice Address - Phone:937-427-4600
Practice Address - Fax:937-427-4520
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006753B207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH458600Medicare PIN