Provider Demographics
NPI:1164640058
Name:BALMER, SUSAN VIRGINIA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VIRGINIA
Last Name:BALMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVE STE 334
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5407
Mailing Address - Country:US
Mailing Address - Phone:906-225-4500
Mailing Address - Fax:906-225-3919
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-4500
Practice Address - Fax:906-225-3919
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301088305207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics