Individual
GWEN ELIZABETH BALOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21710 BEHRING RD, HILLMAN, MI 49746-9103
(989) 306-7253
Mailing address
21710 BEHRING RD, HILLMAN, MI 49746-9103
(989) 306-7253
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0651445599-8
HEALTHCARE PROVIDERS SERVICE ORGANIZATION
MI
Enumeration date
08/29/2018
Last updated
08/29/2018
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