Healthcare Provider Details

I. General information

NPI: 1396572012
Provider Name (Legal Business Name): CAMERON WARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 APPLE TREE DR
IONIA MI
48846-7506
US

IV. Provider business mailing address

375 APPLE TREE DR
IONIA MI
48846-7506
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-1790
  • Fax: 616-527-0538
Mailing address:
  • Phone: 616-527-1790
  • Fax: 616-527-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: