Provider Demographics
NPI:1558604355
Name:FORD, MALIKAH (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:MALIKAH
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 WATSON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1036
Mailing Address - Country:US
Mailing Address - Phone:330-388-4858
Mailing Address - Fax:
Practice Address - Street 1:3535 WATSON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1036
Practice Address - Country:US
Practice Address - Phone:330-388-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400605620407376K00000X
156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
No376K00000XNursing Service Related ProvidersNurse's Aide