Provider Demographics
NPI:1013900802
Name:BALOG, ISTVAN (MD)
Entity type:Individual
Prefix:DR
First Name:ISTVAN
Middle Name:
Last Name:BALOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 BELLE POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-2174
Mailing Address - Country:US
Mailing Address - Phone:912-466-0766
Mailing Address - Fax:912-832-4852
Practice Address - Street 1:1299 GA HWY 57
Practice Address - Street 2:BETWEEN 1-95 AND HWY 17 @ EULONIA
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-8128
Practice Address - Country:US
Practice Address - Phone:912-832-4495
Practice Address - Fax:912-832-4852
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025524207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00293103AMedicaid
GA00293103AMedicaid