Provider Demographics
NPI:1588354138
Name:BALLARD, BRANDON M (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:BALLARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD STE 320
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3141
Mailing Address - Country:US
Mailing Address - Phone:586-580-3062
Mailing Address - Fax:586-580-3143
Practice Address - Street 1:50505 SCHOENHERR RD STE 320
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3141
Practice Address - Country:US
Practice Address - Phone:586-580-3062
Practice Address - Fax:586-580-3143
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601013175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant