Provider Demographics
NPI:1952369274
Name:WARD, DENISE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANN
Last Name:WARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53272 SYLVAN CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9302
Mailing Address - Country:US
Mailing Address - Phone:574-848-7938
Mailing Address - Fax:
Practice Address - Street 1:53272 SYLVAN CT
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IN
Practice Address - Zip Code:46507-9302
Practice Address - Country:US
Practice Address - Phone:574-848-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001445A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114390Medicaid
MI4236951Medicaid
IN100114390Medicaid
IN169130AAMedicare PIN