Provider Demographics
NPI:1811421076
Name:BALL, CHRISTIAN ERIC (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ERIC
Last Name:BALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1728
Mailing Address - Country:US
Mailing Address - Phone:501-920-4030
Mailing Address - Fax:
Practice Address - Street 1:108 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1728
Practice Address - Country:US
Practice Address - Phone:501-920-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY145668213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100586690Medicaid