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Individual

MR. KEITH E. BALLINGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA C

Contact information

Practice address
1000 HEALTH CENTER DR STE 305, MATTOON, IL 61938-4644
(217) 258-4186
(217) 348-4185
Mailing address
PO BOX 372, MATTOON, IL 61938-0372

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
085001872
IL
363A00000X
Physician Assistant
085001872
IL

Other

Enumeration date
08/02/2006
Last updated
10/22/2024
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