Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Brant Michael Balthazor, MS, PA-C

Individual provider Physician Assistant · NPI 1548640774

Brant Michael Balthazor, MS, PA-C is a Physician Assistant in Sheboygan, Wisconsin. Qualified in 2015, 11 years ago. Practices with Wisconsin Spine and Pain SC, a 19-clinician group and accepts Medicare assignment. Licensed in Illinois and Wisconsin.

Years since qualifying
11
Licensed in
IL, WI
In the registry since
2015
Specialties on file
2
What do these letters mean?
MS — Master of Science
A graduate science degree.
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2124 Kohler Memorial Dr
Sheboygan, WI 53081-3169
Phone: (883) 821-7246
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 4424-023 (WI)
Physician Assistant Taxonomy 363A00000X · Licence 085005469 (IL)

Record details

NPI number1548640774
Entity typeIndividual (Type 1)
GenderMale
Credentials MS , PA-C
Sole proprietorNo
NPI enumeratedJune 3, 2015
Last updated in NPPESJanuary 7, 2024
Certification dateJanuary 7, 2024
Mailing address3624 County Road I, Saukville, WI 53080-1446

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Wisconsin Spine And Pain Sc — 19 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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