Provider Demographics
NPI:1316997745
Name:BALLAS, KAREN A (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:A
Last Name:BALLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-295-2949
Mailing Address - Fax:419-628-0642
Practice Address - Street 1:11531 STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-9303
Practice Address - Country:US
Practice Address - Phone:937-295-2949
Practice Address - Fax:419-628-0342
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7129-B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2206697Medicaid
OHG25753Medicare UPIN
OH2206697Medicaid