MEDICARE: RONALD BALLARD PA

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	363A00000X	Physician Assistant	5601002277	MI

General Provider Information

NPI Number	:	1790802775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD BALLARD PA

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8084
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-4161
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:	615-778-9114

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/30/2009

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Directions to “ RONALD BALLARD PA” Practice Location

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