Provider Demographics
NPI:1811095342
Name:BALDING, CARMEN S (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:S
Last Name:BALDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:S
Other - Last Name:MANSILLA-ORIHUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:788 N. JEFFERSON STREET
Mailing Address - Street 2:SUITE 300 / ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3710
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-272-0859
Practice Address - Street 1:375 W. RIVER WOODS PRKWY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-326-1514
Practice Address - Fax:414-326-1574
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47048207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811095342Medicaid
WI1811095342Medicaid
WIK400093618Medicare PIN