Provider Demographics
NPI:1063541571
Name:FORD, STEPHEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:877-632-9292
Mailing Address - Fax:480-635-8111
Practice Address - Street 1:1615 MEDICAL CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5788
Practice Address - Country:US
Practice Address - Phone:719-579-9131
Practice Address - Fax:719-268-1766
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CO34354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00129307OtherRR MEDICARE PYSICIAN ID
CO01343540Medicaid
CO200513841002OtherROCKY MTN HEALTH PLAN
CO601877700OtherDEPT OF LABOR PROVIDER #
CO200513841SOOOtherKAISER PERM PHYSICIAN ID
CO20051384101OtherPACIFICARE PHYSICIAN ID
COFOF39070OtherANTHEM BCBS PYSICIAN ID
CO01343540Medicaid
CO200513841002OtherROCKY MTN HEALTH PLAN
CO200513841SOOOtherKAISER PERM PHYSICIAN ID