Healthcare Provider Details

I. General information

NPI: 1417034901
Provider Name (Legal Business Name): JOHN THOMAS BALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE BOX 19
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

836 WEST WELLINGTON BOX 19
CHICAGO IL
60657-5147
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-3003
  • Fax: 773-296-3002
Mailing address:
  • Phone: 773-296-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036060468
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: