Healthcare Provider Details

I. General information

NPI: 1689201535
Provider Name (Legal Business Name): DANIA BALLICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/26/2024
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 CENTRAL AVE
ST. PETERSBURG FL
33713-8900
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST. PETERSBURG FL
33713-8900
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-1054
  • Fax: 727-821-7213
Mailing address:
  • Phone: 727-322-1054
  • Fax: 727-821-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME163452
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME163452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: