Healthcare Provider Details

I. General information

NPI: 1669095378
Provider Name (Legal Business Name): CRAIG WARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SKOKIE BLVD STE 108-109
NORTHBROOK IL
60062-1613
US

IV. Provider business mailing address

333 SKOKIE BLVD STE 108-109
NORTHBROOK IL
60062-1613
US

V. Phone/Fax

Practice location:
  • Phone: 847-450-6393
  • Fax: 847-919-8375
Mailing address:
  • Phone: 847-450-6393
  • Fax: 847-919-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.008491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: