Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 036127267 | IL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036127267 | IL |
NPI | 1023259777 |
---|---|
Provider Name | Wassim Ballany |
First Address | Evergreen Park, IL 60805-2135 |
Second Address | Evergreen Park, IL 60805-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2009 |
Last Update Date | 20/12/2021 |