Provider Demographics
NPI:1932431202
Name:ERNIE P. BALCUEVA MD PC
Entity Type:Organization
Organization Name:ERNIE P. BALCUEVA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9897-530-1002
Mailing Address - Street 1:800 COOPER AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5373
Mailing Address - Country:US
Mailing Address - Phone:989-753-1002
Mailing Address - Fax:989-753-3460
Practice Address - Street 1:800 COOPER AVE STE 10
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5373
Practice Address - Country:US
Practice Address - Phone:989-753-1002
Practice Address - Fax:989-753-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEB034288207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43225Medicare UPIN