Provider Demographics
NPI:1114923398
Name:WARD, SHAWN C (DPM)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:WARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2725
Mailing Address - Country:US
Mailing Address - Phone:419-225-2726
Mailing Address - Fax:419-228-9909
Practice Address - Street 1:1138 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2725
Practice Address - Country:US
Practice Address - Phone:419-225-2726
Practice Address - Fax:419-228-9909
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003056W213ES0000X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480031634OtherRAILROAD MEDICARE
CB6624OtherRAILROAD MEDICARE
OH2136398Medicaid
OH2136398Medicaid
OH5374990001Medicare NSC
OH9314481Medicare PIN
OH9314481Medicare PIN