Provider Demographics
NPI:1376955682
Name:BALLOUT, HUSSIEN A (MD)
Entity type:Individual
Prefix:
First Name:HUSSIEN
Middle Name:A
Last Name:BALLOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 19TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3555
Mailing Address - Country:US
Mailing Address - Phone:321-387-9451
Mailing Address - Fax:
Practice Address - Street 1:1931 19TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3555
Practice Address - Country:US
Practice Address - Phone:321-387-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131941207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJA255YOtherMEDICARE PTAN
FL021027500Medicaid
FLP02091198OtherRRMEDICARE PTAN
FLJA255ZOtherMEDICARE