Basic Information
| Provider Information | |||||||||
| NPI: | 1316917248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1680 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257171680 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 408 ALEXANDER STREET | ||||||||
| Address2: | |||||||||
| City: | CEDAR GROVE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045951770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 862 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00140986 | 01 | WV | RR MEDICARE | OTHER | 0050082000 | 05 | WV | MEDICAID | 000000178456 | 01 | WV | ANTHEM | OTHER |