Provider Demographics
NPI:1205871548
Name:FAMILY MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:FAMILY MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BALGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-543-7720
Mailing Address - Street 1:111 LANSING ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2400
Mailing Address - Country:US
Mailing Address - Phone:517-543-7720
Mailing Address - Fax:517-543-1125
Practice Address - Street 1:111 LANSING ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2400
Practice Address - Country:US
Practice Address - Phone:517-543-7720
Practice Address - Fax:517-543-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01-00332OtherPHYSICIANS HEALTH PLAN
MI52310314OtherBLUE CARE NETWORK ID
MI0852310314OtherBLUE CROSS BLUE SHIELD
MI007654OtherSTATE LICENSE NUMBER
MI2115222Medicaid
MI007654OtherSTATE LICENSE NUMBER
MI=========OtherFEDERAL TAX ID#
MIF04442Medicare UPIN