Provider Demographics
NPI:1477107035
Name:FORD, ANTHONY ROBERT
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROBERT
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15154 GOULD RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-4206
Mailing Address - Country:US
Mailing Address - Phone:810-705-1017
Mailing Address - Fax:
Practice Address - Street 1:15154 GOULD RD
Practice Address - Street 2:
Practice Address - City:ALLENTON
Practice Address - State:MI
Practice Address - Zip Code:48002-4206
Practice Address - Country:US
Practice Address - Phone:810-705-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider