Provider Demographics
NPI:1568684967
Name:BALLERT, NATALIE M (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:BALLERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7914
Mailing Address - Country:US
Mailing Address - Phone:270-441-4750
Mailing Address - Fax:270-441-4770
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 405
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4750
Practice Address - Fax:270-441-4770
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116017721390200000X
FLME104502207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100125680Medicaid
KY000000670366OtherBCBS
FL146LNOtherBCBS
KY000000670366OtherBCBS
FL146LNOtherBCBS