Provider Demographics
NPI:1487017000
Name:BALKIN, MICHAEL SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:BALKIN
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 1:48 E RIDGE PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2117
Mailing Address - Country:US
Mailing Address - Phone:484-243-6735
Mailing Address - Fax:
Practice Address - Street 1:48 E RIDGE PIKE STE A
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2117
Practice Address - Country:US
Practice Address - Phone:484-243-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5355207P00000X
390200000X
PAMD485255207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program