Basic Information
| Provider Information | |||||||||
| NPI: | 1083775167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALMER BALL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 12903 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402431538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022454301 | ||||||||
| FaxNumber: | 5022445829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21470 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 093688 | 01 | KY | SIHO - NC MA | OTHER | 000000042295 | 01 | KY | ANTHEM | OTHER | 000000548938 | 01 | KY | ANTHEM - NCMA | OTHER | 50030122 | 01 | KY | PASSPORT & PASSPORT ADVTG | OTHER | P00466907 | 01 | KY | RAILROAD MEDICARE | OTHER |