Individual
BRANT MICHAEL BALTHAZOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, PA-C
Contact information
Practice address
2124 KOHLER MEMORIAL DR, SHEBOYGAN, WI 53081-3169
(883) 821-7246
Mailing address
3624 COUNTY ROAD I, SAUKVILLE, WI 53080-1446
(734) 945-3484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085005469
IL
363A00000X
Physician Assistant
Primary
4424-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100100767
—
WI
Enumeration date
06/03/2015
Last updated
01/07/2024
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