Individual
NATHAN SHANE BALUSIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 WATERVILLE MONCLOVA RD, SUITE A, WATERVILLE, OH 43566-1099
(419) 878-3010
(419) 878-3236
Mailing address
900 WATERVILLE MONCLOVA RD, SUITE A, WATERVILLE, OH 43566-1099
(419) 878-3010
(419) 878-3236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.120628
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35 120628
STATE LICENSE
OH
Enumeration date
05/13/2010
Last updated
06/21/2013
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