Provider Demographics
NPI:1801849435
Name:FORD, TIMOTHY C (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:FORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:142 CHENOWETH LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2651
Mailing Address - Country:US
Mailing Address - Phone:502-897-1616
Mailing Address - Fax:502-897-7412
Practice Address - Street 1:142 CHENOWETH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2651
Practice Address - Country:US
Practice Address - Phone:502-897-1616
Practice Address - Fax:502-897-7412
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00181213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4530240001OtherDMERC REGION B
KY80001811Medicaid
KY000000233713OtherANTHEM
KY480034122OtherRAILROAD MEDICARE
KY80001811Medicaid
KY480034122OtherRAILROAD MEDICARE
KY000000233713OtherANTHEM