Healthcare Provider Details

I. General information

NPI: 1508823592
Provider Name (Legal Business Name): HARRY FORD LAWS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND RD
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

9555 76TH STREET 4106
PLEASANT PRAIRIE WI
53158-1984
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-7599
  • Fax:
Mailing address:
  • Phone: 262-653-5437
  • Fax: 262-653-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17708
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01043200A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042.0013318
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66583-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: