Provider Demographics
NPI:1710638366
Name:WARD, MARTIN (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:WARD
Suffix:
Gender:M
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1000
Mailing Address - Country:US
Mailing Address - Phone:708-362-9899
Mailing Address - Fax:
Practice Address - Street 1:18346 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2910
Practice Address - Country:US
Practice Address - Phone:708-362-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician