Provider Demographics
NPI:1720257082
Name:MICHAEL J BALL DPM PA
Entity Type:Organization
Organization Name:MICHAEL J BALL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-483-4448
Mailing Address - Street 1:9080 KIMBERLY BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2862
Mailing Address - Country:US
Mailing Address - Phone:561-483-4448
Mailing Address - Fax:561-483-2167
Practice Address - Street 1:9080 KIMBERLY BLVD
Practice Address - Street 2:STE 7
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2862
Practice Address - Country:US
Practice Address - Phone:561-483-4448
Practice Address - Fax:561-483-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1654213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55610Medicare UPIN
FL0470150001Medicare NSC
FL87930Medicare PIN