MEDICARE: CARLY W WILBUR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35083155	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386745800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY W WILBUR MD

Provider Business Mailing Address
First Line	:	PO BOX 74606
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44194-0689
Country	:	US
Telephone Number	:	216-991-4180
Fax Number	:	216-991-7329

Provider Business Practice Location Address
First Line	:	3461 WARRENSVILLE CENTER RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5260
Country	:	US
Telephone Number	:	216-383-0100
Fax Number	:	216-383-6481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/29/2012

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Directions to “ CARLY W WILBUR MD” Practice Location

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