Provider Demographics
NPI:1245285766
Name:BALKOVETZ, DANIEL F (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:BALKOVETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15820207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000083909Medicaid
AL000083917Medicaid
AL009968570Medicaid
AL700007698OtherRAILROAD MEDICARE
AL000083917OtherBLUE CROSS
AL051500524OtherBLUE CROSS
AL16429OtherHEALTHSPRING
AL051510646OtherBLUE CROSS
AL000083909OtherBLUE CROSS
AL009900035Medicaid
ALE93006OtherVIVA
AL000083917Medicaid
AL000083917Medicare ID - Type Unspecified