Individual
TIFFANY WARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
305 W JACKSON ST STE 103, CARBONDALE, IL 62901-1474
(618) 351-4972
(618) 351-6522
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036141201
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
GROUP MEDICARE PTAN
IL
Enumeration date
05/21/2007
Last updated
11/03/2022
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