Healthcare Provider Details

I. General information

NPI: 1114926748
Provider Name (Legal Business Name): CURTIS L WARD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 N GLEN PARK PLACE RD
PEORIA IL
61614-4677
US

IV. Provider business mailing address

4427 W JEWELWOOD CT
PEORIA IL
61615-8933
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-1589
  • Fax: 309-692-2032
Mailing address:
  • Phone: 309-692-1847
  • Fax: 309-692-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016002924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: