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Organization
R S BALBOA MDPC
Active
Organization
R S BALBOA MDPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALDO S BALBOA MD (OWNER)
(810) 966-9556
Entity
Organization
Contact information
Practice address
1201 STONE ST STE 5, PORT HURON, MI 48060-3563
(810) 966-9556
(810) 966-4898
Mailing address
1201 STONE ST STE 5, PORT HURON, MI 48060-3563
(810) 966-9556
(810) 966-4898
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
RB028997
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0740374
BCBSM
MI
05
—
1006297
—
MI
01
—
110094613
RAILROAD MEDICARE
MI
Enumeration date
06/29/2009
Last updated
12/15/2009
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