Provider Demographics
NPI:1215935085
Name:FORD, IRIS (DO)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6142
Mailing Address - Country:US
Mailing Address - Phone:630-321-8300
Mailing Address - Fax:630-321-8750
Practice Address - Street 1:3839 92ND ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9705
Practice Address - Country:US
Practice Address - Phone:616-914-1787
Practice Address - Fax:231-237-4639
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081804207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532206OtherBLUE CROSS BLUE SHIELD
IL036081804Medicaid
ILP00184976Medicare PIN
IL036081804Medicaid
ILC69178Medicare UPIN
ILK10449Medicare PIN