Healthcare Provider Details

I. General information

NPI: 1497999007
Provider Name (Legal Business Name): ELIZABETH A FORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MONROE ST UNIT 203
SYLVANIA OH
43560-2735
US

IV. Provider business mailing address

5700 MONROE ST UNIT 203
SYLVANIA OH
43560-2735
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-8100
  • Fax: 419-841-4681
Mailing address:
  • Phone: 419-843-8100
  • Fax: 419-841-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.096579
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: