1871797258 NPI number — DR. CLIFTON JOSEPH WARD JR. MD

Table of content: DR. CLIFTON JOSEPH WARD JR. MD (NPI 1871797258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871797258 NPI number — DR. CLIFTON JOSEPH WARD JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
CLIFTON
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871797258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 FOREST BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARK FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60466-1755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-748-2474
Provider Business Mailing Address Fax Number:
708-709-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 E 15TH STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CHICAGO HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60411-3459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-709-2000
Provider Business Practice Location Address Fax Number:
708-709-2046
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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