Individual
MR. ANDRE BALLINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4488 W BROAD ST, COLUMBUS, OH 43228-5610
(614) 746-6746
Mailing address
3445 EDENHURST ST, COLUMBUS, OH 43224-3004
(614) 475-3429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
33.019992
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12505340
CAQH
OH
Enumeration date
02/25/2013
Last updated
02/25/2013
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