Individual
MARY BALKOVETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15869
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000083917
—
AL
01
—
010055307
RAILROAD MEDICARE
AL
01
—
83917
BCBS OF ALABAMA
AL
01
—
E90756
VIVA
AL
Enumeration date
05/30/2006
Last updated
07/21/2011
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