Provider Demographics
NPI:1376594473
Name:FORD, JAMES PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:FORD
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: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:408-660-0431
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004746-4Medicaid
IL02207597OtherBC / BS
IL02207597OtherBC / BS
IL380871Medicare ID - Type UnspecifiedWISC. PHYS. SVCS.