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General NPI Number Information
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NPI Number | 1164779401
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Entity Type | Organization
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Legal Business Name | JAMES P FORD
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 1142 CHICAGO AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1837
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Country | US
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Telephone | 708-660-0889
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Fax | 708-660-0431
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Provider Business Mailing Address
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Address Line | PO BOX 164
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City | OAK PARK
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State | IL
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Zip | 60303-0164
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Country | US
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Telephone | 708-660-0889
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Fax | 708-660-0431
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | JAMES PATRICK FORD
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Credential | DPM
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Telephone | 708-660-0431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-004746
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License Number State | IL
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