Provider Demographics
NPI:1164779401
Name:JAMES P FORD
Entity Type:Organization
Organization Name:JAMES P FORD
Other - Org Name:THE OAK PARK PODIATRIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-660-0431
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-0164
Mailing Address - Country:US
Mailing Address - Phone:708-660-0889
Mailing Address - Fax:708-660-0431
Practice Address - Street 1:1142 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1837
Practice Address - Country:US
Practice Address - Phone:708-660-0889
Practice Address - Fax:708-660-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004746213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU51264Medicare UPIN
IL213902Medicare PIN
IL380870Medicare PIN