Provider Demographics
NPI:1811135775
Name:BALCERZAK, ANTHONY FRANK (OWNER)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANK
Last Name:BALCERZAK
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38516 N GRATIOT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP,MI, 48036:
Mailing Address - State:MI
Mailing Address - Zip Code:48047
Mailing Address - Country:US
Mailing Address - Phone:586-463-8801
Mailing Address - Fax:586-463-8804
Practice Address - Street 1:38516 N GRATIOT AVENUE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-463-8801
Practice Address - Fax:586-463-8804
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB203734287225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider