Provider Demographics
NPI:1760481022
Name:BALLEN, ANN E (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:BALLEN
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 1:8501 SW 124TH AVE
Mailing Address - Street 2:109
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4627
Mailing Address - Country:US
Mailing Address - Phone:305-271-4544
Mailing Address - Fax:305-274-9668
Practice Address - Street 1:8501 SW 124TH AVE
Practice Address - Street 2:109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:305-271-4544
Practice Address - Fax:305-274-9668
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047233174400000X
FLME47233207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043855300Medicaid