Healthcare Provider Details

I. General information

NPI: 1114923398
Provider Name (Legal Business Name): SHAWN C WARD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 W HIGH ST
LIMA OH
45805-2725
US

IV. Provider business mailing address

1138 W HIGH ST
LIMA OH
45805-2725
US

V. Phone/Fax

Practice location:
  • Phone: 419-225-2726
  • Fax: 419-228-9909
Mailing address:
  • Phone: 419-225-2726
  • Fax: 419-228-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number36003056W
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36003056W
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003056W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: