MEDICARE: NERMILA ASHA BALLMICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	21523	NV

General Provider Information

NPI Number	:	1588168256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NERMILA ASHA BALLMICK MD

Provider Business Mailing Address
First Line	:	3129 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	725-220-8457
Fax Number	:	833-749-0355

Provider Business Practice Location Address
First Line	:	3129 N RAINBOW BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4578
Country	:	US
Telephone Number	:	725-220-8457
Fax Number	:	833-749-0355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	01/26/2022

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