Provider Demographics
NPI:1396943858
Name:MATERNAL-FETAL MEDICINE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MATERNAL-FETAL MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:BALASKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-285-3310
Mailing Address - Street 1:1000 E PARIS AVE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3691
Mailing Address - Country:US
Mailing Address - Phone:616-285-3310
Mailing Address - Fax:616-285-3266
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 210
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-285-3310
Practice Address - Fax:616-285-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty