Provider Demographics
NPI:1932186194
Name:WARD, JOHN B (MBBCH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:WARD
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:395 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1425
Practice Address - Country:US
Practice Address - Phone:317-770-5861
Practice Address - Fax:317-770-5867
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038325207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000355675OtherANTHEM
IN100324980Medicaid
IN306140KMedicare PIN
IN100324980Medicaid
IN000000355675OtherANTHEM
IN316990PMedicare PIN
IN177280A5Medicare PIN