Provider Demographics
NPI:1720013766
Name:WARD, EDWARD J III (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:WARD
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-377-7900
Mailing Address - Fax:630-377-8007
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-377-7900
Practice Address - Fax:630-377-8007
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-02-19
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Provider Licenses
StateLicense IDTaxonomies
IL036100523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherBLUE CROSS GROUP NUMBER
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL036100523Medicaid
IL080159106Medicare PIN
IL363149833OtherTAX IDENTIFICATION NUMBER
IL0222075OtherBLUE CROSS GROUP NUMBER