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NPI Code Detail

MEDICARE: SUSAN R BALLINGER MD

MEDICARE: SUSAN R BALLINGER 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
12080P0216XPediatric Rheumatology Physician01042632IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780793869
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN R BALLINGER MD
Provider Business Mailing Address
First Line : PO BOX 719094
Second Line :
City : CHICAGO
State : IL
Zip : 60677-9318
Country : US
Telephone Number : 317-777-6435
Fax Number : 317-777-6644
Provider Business Practice Location Address
First Line : 705 RILEY HOSPITAL DR
Second Line : RR 307
City : INDIANAPOLIS
State : IN
Zip : 46202-5109
Country : US
Telephone Number : 317-274-2172
Fax Number : 317-274-3031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 04/13/2026

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Directions to “ SUSAN R BALLINGER MD” Practice Location

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