Provider Demographics
NPI:1861494965
Name:BALON, DENISE HILLARD (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:HILLARD
Last Name:BALON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15990 WEST NINE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2527
Mailing Address - Country:US
Mailing Address - Phone:248-849-4226
Mailing Address - Fax:248-849-4240
Practice Address - Street 1:210 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2048
Practice Address - Country:US
Practice Address - Phone:248-437-1744
Practice Address - Fax:248-437-3245
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI410852110Medicaid
MI0F360200811Medicare ID - Type Unspecified
MI410852110Medicaid