MEDICARE: DR. KENNETH WARD MD

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	207SG0201X	Clinical Genetics (M.D.) Physician	170113-1205	UT
2	207SG0203X	Clinical Molecular Genetics Physician	170113-1205	UT
3	207VM0101X	Maternal & Fetal Medicine Physician	170113-1205	UT

General Provider Information

NPI Number	:	1487641437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WARD MD

Provider Business Mailing Address
First Line	:	2749 E PARLEYS WAY
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1660
Country	:	US
Telephone Number	:	801-582-4200
Fax Number	:	801-582-8460

Provider Business Practice Location Address
First Line	:	2749 E PARLEYS WAY
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1660
Country	:	US
Telephone Number	:	801-582-4200
Fax Number	:	801-582-8460

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/03/2013

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