BRANT MICHAEL BALTHAZOR MS, PA-C
Individual Provider (NPI-1)
Active
Physician Assistant
Provider Information
- NPI Number
1548640774- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MS, PA-C
- Status
- Active
Contact & Location
- Address
- 2124 KOHLER MEMORIAL DR, SHEBOYGAN, WI, 530813169
- Phone
- (883) 821-7246
Specialties & Taxonomies
Physician Assistant
License: IL #085005469
Physician Assistant
Primary License: WI #4424-023