| R S Balboa Mdpc | |
|
1201 Stone St Ste 5 Port Huron MI 48060-3563 | |
| (810) 966-9556 | |
| (810) 966-4898 |
| Full Name | R S Balboa Mdpc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1201 Stone St Ste 5, Port Huron, Michigan |
| Authorized Official Name and Position | Ronaldo S Balboa (OWNER) |
| Authorized Official Contact | 8109669556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R S Balboa Mdpc 1201 Stone St Ste 5 Port Huron MI 48060-3563 Ph: (810) 966-9556 | R S Balboa Mdpc 1201 Stone St Ste 5 Port Huron MI 48060-3563 Ph: (810) 966-9556 |
| NPI Number | 1801024807 |
|---|---|
| Provider Enumeration Date | 06/29/2009 |
| Last Update Date | 12/15/2009 |
| Medicare PECOS PAC ID | 8022161793 |
|---|---|
| Medicare Enrollment ID | O20090728000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801024807 | NPI | - | NPPES |
| 110094613 | Other | MI | RAILROAD MEDICARE |
| 1006297 | Medicaid | MI | |
| 0740374 | Other | MI | BCBSM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | RB028997 (Michigan) | Primary |
| Provider Name | Ronaldo Salcedo Balboa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417941055 PECOS PAC ID: 7012826886 Enrollment ID: I20090728000335 |
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