Healthcare Provider Details

I. General information

NPI: 1356863658
Provider Name (Legal Business Name): JAD BALLOUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD STE 400
LEXINGTON KY
40503-1475
US

IV. Provider business mailing address

1720 NICHOLASVILLE RD STE 400
LEXINGTON KY
40503-1475
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5887
  • Fax: 859-276-7659
Mailing address:
  • Phone: 859-277-5887
  • Fax: 859-276-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number53983
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: