Provider Demographics
NPI:1730184789
Name:BALLOU, MICHELE K (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:K
Last Name:BALLOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:K
Other - Last Name:KRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:866-903-6621
Practice Address - Street 1:200 ARH LANE
Practice Address - Street 2:STE. 102
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457-0007
Practice Address - Country:US
Practice Address - Phone:540-862-6710
Practice Address - Fax:540-862-9167
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036698207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006099483Medicaid
VA110137211Medicare PIN
VA006099483Medicaid
VA110006742Medicare PIN