Provider Demographics
NPI:1871786590
Name:BALKANSKY, ALAN L (DPM)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:BALKANSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404A N LOVERS LANE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3006
Mailing Address - Country:US
Mailing Address - Phone:414-442-3400
Mailing Address - Fax:414-442-0344
Practice Address - Street 1:5404A N LOVERS LANE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3006
Practice Address - Country:US
Practice Address - Phone:414-442-3400
Practice Address - Fax:414-442-0344
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI429-025213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery