MEDICARE: JAMES P FORD

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	213E00000X	Podiatrist	016-004746	IL

General Provider Information

NPI Number	:	1164779401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES P FORD

Provider Business Mailing Address
First Line	:	PO BOX 164
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60303-0164
Country	:	US
Telephone Number	:	708-660-0889
Fax Number	:	708-660-0431

Provider Business Practice Location Address
First Line	:	1142 CHICAGO AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1837
Country	:	US
Telephone Number	:	708-660-0889
Fax Number	:	708-660-0431

Authorized Official
Title or Position	:	SOLE PROPRIETER
Name	:	JAMES PATRICK FORD
Credential	:	DPM
Telephone Number	:	708-660-0431

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/20/2012

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