Brant Michael Balthazor, MS, PA-C

Physician Assistant · Sheboygan, WI

Individual Active NPI

NPI number 1548640774

Practice location

2124 Kohler Memorial Dr
Sheboygan, WI 53081-3169
Phone
(883) 821-7246

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NPI record

NPI
1548640774
Entity type
Individual (Type 1)
Enumeration date
June 3, 2015
Last updated
January 7, 2024
Certified
January 7, 2024
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 4424-023 WI
Physician Assistant 363A00000X 085005469 IL

Mailing address

3624 County Road I
Saukville, WI 53080-1446
Phone
(734) 945-3484

About Brant Balthazor

Brant Michael Balthazor, MS, PA-C is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 2124 Kohler Memorial Dr, Sheboygan, WI 53081-3169. The NPI number 1548640774 was assigned on June 3, 2015 and the record was last updated on January 7, 2024.

Brant Balthazor lists 2 licenses in the registry: #4424-023 (WI) for Physician Assistant; #085005469 (IL) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Brant Michael Balthazor, MS, PA-C?

The NPI number is 1548640774.

What is the phone number of Brant Balthazor?

The phone number listed for the practice location is (883) 821-7246.

Where is Brant Balthazor located?

2124 Kohler Memorial Dr, Sheboygan, WI 53081-3169.

What is the taxonomy code for Brant Balthazor?

The primary taxonomy code is 363A00000X – Physician Assistant; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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