Provider Demographics
NPI:1508208224
Name:WARD, ALICIA LIANNE (DPM)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LIANNE
Last Name:WARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:LIANNE
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:641 W 9 MILE RD STE A
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1779
Mailing Address - Country:US
Mailing Address - Phone:248-548-7363
Mailing Address - Fax:248-548-6732
Practice Address - Street 1:641 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1779
Practice Address - Country:US
Practice Address - Phone:248-548-7363
Practice Address - Fax:248-548-7363
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery