Doctor Name: | DR. JAIME T BALLESTEROS |
NPI Number: | 1437154432 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301046964 |
Business Practice Address: | G3239 Beecher Rd Ste C Flint, MI - 485323616 |
Business Phone Number: | 8107329222 |
Business Fax Number: | 8107324344 |
Mailing Address: | G3239 Beecher Rd, Ste C FLINT |
State: | MI |
Postal Code: | 485323616 |
Phone Number: | 8107329222 |
Fax Number: | 8107324344 |
NPI Enumeration Date: | 06/16/2005 |
NPI Last Update Date: | 06/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 4301046964 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |