Provider Demographics
NPI:1821065723
Name:BALL, CAROL ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELIZABETH
Last Name:BALL
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 1:9809 85TH ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 LAGOON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2077
Practice Address - Country:US
Practice Address - Phone:612-823-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24235207V00000X
SD5497207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1007730OtherPREFERRED ONE PROVIDER #
MN873793200Medicaid
MN437T6BAOtherBCBS PROVIDER #
07-03805OtherMEDICA PROVIDER #
HP15829OtherHEALTH PARTNERS' #
SD6201350Medicaid
887945OtherAMERICA'S PPO (ARAZ)
36606OtherSIOUX VALLEY PROVIDER #
SD6201352Medicaid
103977OtherUCARE PROVIDER #
SD6201352Medicaid
103977OtherUCARE PROVIDER #
MN437T6BAOtherBCBS PROVIDER #
D80261Medicare UPIN
MN873793200Medicaid