MEDICARE: APIWAT FORD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	036081772	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532206	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053319822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APIWAT FORD DO

Provider Business Mailing Address
First Line	:	3707 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7530
Country	:	US
Telephone Number	:	815-338-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 DOTY RD
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7530
Country	:	US
Telephone Number	:	815-338-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/21/2022

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Directions to “ APIWAT FORD DO” Practice Location

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