Provider Demographics
NPI:1750487914
Name:BALLARD, RACHEL RUSHTON (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RUSHTON
Last Name:BALLARD
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 E CHICAGO AVE
Mailing Address - Street 2:BOX 10
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-6650
Mailing Address - Fax:312-227-9656
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 10
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-6650
Practice Address - Fax:312-227-9656
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134917208000000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD0117424OtherDPS
TXK9720OtherLICENSE
TX047715004Medicaid
TXTXB111024OtherMEDICARE PECOS
TXTXB111024OtherMEDICARE PECOS
TXD0117424OtherDPS