Provider Demographics
NPI:1528006483
Name:WARD, MERRILL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:MERRILL
Middle Name:CRAIG
Last Name:WARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13101 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-9068
Mailing Address - Country:US
Mailing Address - Phone:309-792-9363
Mailing Address - Fax:
Practice Address - Street 1:1315 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3737
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-088245207P00000X
SC12996207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C68730OtherTRICARE
054347OtherHEALTH ALLIANCE
930022047OtherRAILROAD MEDICARE
ILC68730OtherBLUE CROSS BLUE SHIELD
IA96939OtherBLUE CROSS BLUE SHIELD
ILK30948Medicare ID - Type Unspecified