Healthcare Provider Details

I. General information

NPI: 1871812438
Provider Name (Legal Business Name): TIFFANY BALLARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WASHTENAW AVE STE A
ANN ARBOR MI
48104-4558
US

IV. Provider business mailing address

2320 WASHTENAW AVE STE A
ANN ARBOR MI
48104-4558
US

V. Phone/Fax

Practice location:
  • Phone: 734-913-5100
  • Fax:
Mailing address:
  • Phone: 734-913-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301096304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: