Healthcare Provider Details

I. General information

NPI: 1134122831
Provider Name (Legal Business Name): MICHAEL W WARD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DELHI ST STE 2200
DUBUQUE IA
52001-6359
US

IV. Provider business mailing address

1951 S GRANDVIEW AVE
DUBUQUE IA
52003-7922
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-5930
  • Fax: 563-557-5936
Mailing address:
  • Phone: 563-583-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number323
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: