Provider Demographics
NPI:1679506778
Name:FRANK BALLESTERIS MD PA
Entity Type:Organization
Organization Name:FRANK BALLESTERIS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305786-201-4458
Mailing Address - Street 1:946 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4270
Mailing Address - Country:US
Mailing Address - Phone:786-201-4458
Mailing Address - Fax:
Practice Address - Street 1:946 SW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4270
Practice Address - Country:US
Practice Address - Phone:786-201-4458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE23012Medicare UPIN