Provider Demographics
NPI:1871797258
Name:WARD, CLIFTON JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:JOSEPH
Last Name:WARD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 FOREST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PARK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60466-1755
Mailing Address - Country:US
Mailing Address - Phone:708-748-2474
Mailing Address - Fax:708-709-2046
Practice Address - Street 1:30 E 15TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-709-2000
Practice Address - Fax:708-709-2046
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
S37240Medicare UPIN