1730987587 NPI number — DR. STEPHANIE ANN BALOW PHD, FACMG

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730987587 NPI number — DR. STEPHANIE ANN BALOW PHD, FACMG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALOW
Provider First Name:
STEPHANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, FACMG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730987587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 BURNET AVENUE
Provider Second Line Business Mailing Address:
MLC 7016
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-803-4474
Provider Business Mailing Address Fax Number:
513-636-4373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 BURNET AVENUE
Provider Second Line Business Practice Location Address:
MLC 7016
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-803-4474
Provider Business Practice Location Address Fax Number:
513-636-4373
Provider Enumeration Date:
03/06/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247ZC0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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