Provider Demographics
NPI:1962533604
Name:MICHAEL A. BALLARD, MD INC.
Entity type:Organization
Organization Name:MICHAEL A. BALLARD, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-294-7872
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-0727
Mailing Address - Country:US
Mailing Address - Phone:225-294-7872
Mailing Address - Fax:225-294-7872
Practice Address - Street 1:13135 E ADAMS RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2123
Practice Address - Country:US
Practice Address - Phone:225-294-7872
Practice Address - Fax:225-294-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.09071R207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1929247Medicaid
LA5CE02Medicare ID - Type UnspecifiedGROUP NUMBER
LA5N981Medicare ID - Type Unspecified
LA1929247Medicaid