Provider Demographics
NPI:1114926748
Name:WARD, CURTIS L (DPM)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:L
Last Name:WARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 W JEWELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-8933
Mailing Address - Country:US
Mailing Address - Phone:309-692-1847
Mailing Address - Fax:309-692-5364
Practice Address - Street 1:5017 N GLEN PARK PLACE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4677
Practice Address - Country:US
Practice Address - Phone:309-691-1589
Practice Address - Fax:309-692-2032
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002924213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002924Medicaid
IDP15981Medicare PIN
IL0926880001Medicare NSC
IDL37907Medicare PIN
IL732420Medicare UPIN
IL732422Medicare ID - Type Unspecified
IL016002924Medicaid
ILT35404Medicare UPIN