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Individual

CHRISTOPHER W BALLARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
213 NW 10TH STREET, SUITE A, FAIRFIELD, IL 62837
(618) 842-4617
(618) 842-4743
Mailing address
213 NW 10TH ST, SUITE A, FAIRFIELD, IL 62837-1219
(618) 842-4617
(618) 842-4743

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036110162
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036110162
IL
01
820900
MEDICARE GROUP
Enumeration date
06/23/2005
Last updated
03/03/2021
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