Individual
ROBERT LOUIS BALESTRERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1100 E MICHIGAN AVE, GRAYLING, MI 49738-1312
(989) 348-0859
Mailing address
1100 E MICHIGAN AVE, GRAYLING, MI 49738-1312
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD061337L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104990023
—
MI
01
—
3002012141
BLUE SHIELD
MI
Enumeration date
05/16/2006
Last updated
03/07/2023
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