Healthcare Provider Details

I. General information

NPI: 1801849435
Provider Name (Legal Business Name): TIMOTHY C FORD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CHENOWETH LN
LOUISVILLE KY
40207-2651
US

IV. Provider business mailing address

142 CHENOWETH LN
LOUISVILLE KY
40207-2651
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-1616
  • Fax: 502-897-7412
Mailing address:
  • Phone: 502-897-1616
  • Fax: 502-897-7412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000756A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00181
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: