Robert Louis Balestrero, MD
Individual provider Active NPI Diagnostic Radiology Physician · Grayling, MI
NPI 1790737070 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1790737070
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- MD061337L (PA)
- Practice address
- 1100 E Michigan Ave
Grayling, MI 49738-1312 - Phone
- (989) 348-0859
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD061337L | PA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles Cole Memorial D/B/a Upmc Cole | Past | Accepting new patients | |
| Charles Cole Memorial Hospital | Past | Accepting new patients | |
| Charles Cole Memorial Hospital D/B/a Upmc Cole | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | MD061337L | PA | Yes |
Addresses
Primary practice location
1100 E Michigan Ave
Grayling, MI 49738-1312
Mailing address
1100 E Michigan Ave
Grayling, MI 49738-1312
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3002012141 | Other | MI | BLUE SHIELD |
| 104990023 | Medicaid | MI |
Other providers in Grayling, MI
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- Ausable Medical Associates, PC
- Ausable Primary Care PC
- Ausable Urology, P.C.
- Jewell Barnard
- Baruch SLS, Inc.
- Margaret Katherine Behre
- Jason Bennett
- Chloe Biggs
All providers in Grayling, MI · Diagnostic Radiology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.