MEDICARE: JAMES PATRICK FORD D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	02207597	OTHER	IL	BC / BS

General Provider Information

NPI Number	:	1376594473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES PATRICK FORD D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 164
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60303-0164
Country	:	US
Telephone Number	:	708-660-0889
Fax Number	:	408-660-0431

Provider Business Practice Location Address
First Line	:	1142 CHICAGO AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:	708-660-0889
Fax Number	:	708-660-0431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/09/2007

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