Provider Demographics
NPI:1134122831
Name:WARD, MICHAEL W (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
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 1:1951 S GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-7922
Mailing Address - Country:US
Mailing Address - Phone:563-583-5481
Mailing Address - Fax:
Practice Address - Street 1:1500 DELHI ST
Practice Address - Street 2:STE 2200
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6359
Practice Address - Country:US
Practice Address - Phone:563-557-5930
Practice Address - Fax:563-557-5936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA323213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0127902Medicaid
IA0127902Medicaid
IA53089Medicare ID - Type Unspecified