| L. Douglas Balke Md Plc | |
|
143 N Mccormick St Ste 103 Prescott AZ 86301-2725 | |
| (928) 235-6346 | |
| (928) 272-4264 |
| Full Name | L. Douglas Balke Md Plc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 143 N Mccormick St Ste 103, Prescott, Arizona |
| Authorized Official Name and Position | Len Balke (OWNER/PROVIDER) |
| Authorized Official Contact | 9709039993 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| L. Douglas Balke Md Plc 845 Crystal View Dr Prescott AZ 86301-6696 Ph: (928) 235-6346 | L. Douglas Balke Md Plc 143 N Mccormick St Ste 103 Prescott AZ 86301-2725 Ph: (928) 235-6346 |
| NPI Number | 1093449761 |
|---|---|
| Provider Enumeration Date | 07/10/2022 |
| Last Update Date | 07/10/2022 |
| Certification Date | 07/10/2022 |
| Medicare PECOS PAC ID | 6507247616 |
|---|---|
| Medicare Enrollment ID | O20220721000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093449761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Len Douglas Balke |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992787527 PECOS PAC ID: 7315022159 Enrollment ID: I20141118001889 |
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