Provider Demographics
NPI:1972604114
Name:BALAJ, SEYMOURE SR
Entity Type:Individual
Prefix:DR
First Name:SEYMOURE
Middle Name:
Last Name:BALAJ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SEYMOURE
Other - Middle Name:
Other - Last Name:BALAJ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:25520 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1377
Mailing Address - Country:US
Mailing Address - Phone:248-398-2815
Mailing Address - Fax:
Practice Address - Street 1:25520 KAREN STREET
Practice Address - Street 2:27600 NORTHWESTERN HIGHWAY SUITE 260
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-355-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400060213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine