Healthcare Provider Details

I. General information

NPI: 1013666254
Provider Name (Legal Business Name): ISAAC WILMOT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W SAINT MAARTENS DR STE A
SAINT JOSEPH MO
64506-2989
US

IV. Provider business mailing address

1005 W SAINT MAARTENS DR STE A
SAINT JOSEPH MO
64506-2989
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-2338
  • Fax: 816-364-1003
Mailing address:
  • Phone: 816-364-2338
  • Fax: 816-364-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2026021149
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004201
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36.004201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: