MEDICARE: CHRISTIAN BALLAST 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	207R00000X	Internal Medicine Physician	01038703A	IN
2	208000000X	Pediatrics Physician	01038703A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720025174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN BALLAST MD

Provider Business Mailing Address
First Line	:	1626 E STATE ROAD 44
Second Line	:	STE A
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-4057
Country	:	US
Telephone Number	:	317-421-2012
Fax Number	:	317-398-1852

Provider Business Practice Location Address
First Line	:	2158 INTELLIPLEX DR
Second Line	:	SUITE 200
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-392-3651
Fax Number	:	317-398-0538

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/23/2016

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Directions to “ CHRISTIAN BALLAST MD” Practice Location

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