Provider Demographics
NPI:1538119557
Name:BALL, TERRY (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2853 HEALTH PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3872
Mailing Address - Country:US
Mailing Address - Phone:989-775-7641
Mailing Address - Fax:989-775-6472
Practice Address - Street 1:2853 HEALTH PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3872
Practice Address - Country:US
Practice Address - Phone:989-775-7641
Practice Address - Fax:989-775-6472
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-11-04
Deactivation Date:2006-05-19
Deactivation Code:
Reactivation Date:2006-06-14
Provider Licenses
StateLicense IDTaxonomies
MI5101012938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000005465OtherHEALTHPLUS
MI4321248-11Medicaid
MI01-01951OtherPHP COMMERCIAL
MI0153700165OtherBCBS
MI1006927OtherMCLAREN HEALTH PLAN
MI01-01951OtherPHP COMMERCIAL
MI1006927OtherMCLAREN HEALTH PLAN