Provider Demographics
NPI:1932798535
Name:FORD, DEWAN M
Entity Type:Individual
Prefix:
First Name:DEWAN
Middle Name:M
Last Name:FORD
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 1:2252 BROCKWAY RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3050
Mailing Address - Country:US
Mailing Address - Phone:216-688-8476
Mailing Address - Fax:
Practice Address - Street 1:2252 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3050
Practice Address - Country:US
Practice Address - Phone:216-688-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker