Provider Demographics
NPI:1720856826
Name:WARD, GREGORY M
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:M
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RIDGEMONT CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1222
Mailing Address - Country:US
Mailing Address - Phone:313-290-4200
Mailing Address - Fax:
Practice Address - Street 1:5 RIDGEMONT CT
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1222
Practice Address - Country:US
Practice Address - Phone:313-290-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide