=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083587935
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW MICHAEL BALL PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HURLEY PLZ
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48503-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-262-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 67988 LAKE ANGELA DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48062-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-863-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5601013387
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------