Provider Demographics
NPI:1730147034
Name:BALCAREK, KYTIA S (MD)
Entity type:Individual
Prefix:
First Name:KYTIA
Middle Name:S
Last Name:BALCAREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:993 F JOHNSON FERRY RD
Mailing Address - Street 2:STE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-4611
Mailing Address - Fax:404-256-1759
Practice Address - Street 1:993 F JOHNSON FERRY RD
Practice Address - Street 2:STE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-4611
Practice Address - Fax:404-256-1759
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA045713208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65538Medicare UPIN
GA37BBFFHMedicare ID - Type Unspecified