Provider Demographics
NPI:1992458822
Name:WASSIM BALLAN MD PLLC
Entity type:Organization
Organization Name:WASSIM BALLAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WASSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-317-1304
Mailing Address - Street 1:PO BOX 8022
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-8022
Mailing Address - Country:US
Mailing Address - Phone:214-383-8360
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS ROAD
Practice Address - Street 2:INFECTION CONTROL DEPT - PCH
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:480-636-1149
Practice Address - Fax:214-383-8360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty