Provider Demographics
NPI:1699735415
Name:ALWARD, PHILLIP D (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:ALWARD
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 1:2020 W ILES AVNEUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7015
Mailing Address - Country:US
Mailing Address - Phone:217-698-3030
Mailing Address - Fax:217-698-4728
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 311
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-698-3030
Practice Address - Fax:217-698-4728
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054803207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054803Medicaid
IL180022789OtherRR MEDICARE
IL180022789OtherRR MEDICARE
IL1116720001Medicare NSC
ILL33535Medicare PIN
ILL33534Medicare PIN
IL180022789OtherRR MEDICARE
IL352450Medicare ID - Type Unspecified
IL1116720001Medicare NSC