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General NPI Number Information
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NPI Number | 1902374267
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Entity Type | Individual
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Provider Name | GREGORY SCOTT BALLOID NP
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Gender | Male
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 35 MICHIGAN ST NE STE 3003
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2528
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Country | US
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Telephone | 616-267-2570
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE # MC845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704289789NSA180SS
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704289789
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License Number State | MI
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