Individual
MIAH MARIE FORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
945 N 12TH ST, MILWAUKEE, WI 53233-1305
(414) 219-2000
Mailing address
820 S 91ST ST, WEST ALLIS, WI 53214-2845
(319) 215-5932
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7645-23
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262236
—
WI
Enumeration date
08/08/2022
Last updated
04/25/2024
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