Provider Demographics
NPI:1245324268
Name:BALKOVEC, EUGENE S (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:S
Last Name:BALKOVEC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670629
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-0629
Mailing Address - Country:US
Mailing Address - Phone:216-640-9525
Mailing Address - Fax:
Practice Address - Street 1:15003 TURNEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4730
Practice Address - Country:US
Practice Address - Phone:216-640-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000136584OtherANTHEM
OHT01954OtherSUMMA
OH0171648Medicaid
791011214OtherRAILROAD MEDICARE
791011214OtherRAILROAD MEDICARE
OH000000136584OtherANTHEM