Provider Demographics
NPI:1801066527
Name:GENE A BALIS MD AND KENNETH M LOUIS MDNEUROLOGICAL SURGERY ASSOCIATES
Entity type:Organization
Organization Name:GENE A BALIS MD AND KENNETH M LOUIS MDNEUROLOGICAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-977-3776
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-977-3776
Mailing Address - Fax:813-977-3777
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-977-3776
Practice Address - Fax:813-977-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0028912207T00000X
FLME0041511207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38183OtherBCBS
FLDN725AMedicare PIN