Provider Demographics
NPI:1275559338
Name:BALL, THOMAS JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:BALL
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37506 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3511
Mailing Address - Country:US
Mailing Address - Phone:586-438-2672
Mailing Address - Fax:586-438-2678
Practice Address - Street 1:37506 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3511
Practice Address - Country:US
Practice Address - Phone:586-438-2672
Practice Address - Fax:586-438-2678
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001013213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT34312Medicare UPIN