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General NPI Number Information
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NPI Number | 1134807506
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Entity Type | Individual
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Provider Name | MICHAELLA MARIE FORD OD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 3241 S MICHIGAN AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60616-3878
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Country | US
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Telephone | 312-949-7119
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Fax | 312-949-7617
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Provider Business Mailing Address
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Address Line | 4499 TOWN CENTER PKWY
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City | FLINT
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State | MI
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Zip | 48532-3425
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Country | US
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Telephone | 810-691-2450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046011769
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901005759
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License Number State | MI
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