MEDICARE: MADISON BALLARD

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		FL

General Provider Information

NPI Number	:	1861333569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON BALLARD

Provider Business Mailing Address
First Line	:	1010 S OCEAN BLVD APT 905
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-6631
Country	:	US
Telephone Number	:	954-941-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E SAMPLE RD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33064-3502
Country	:	US
Telephone Number	:	954-941-8300
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ MADISON BALLARD ” Practice Location

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