Healthcare Provider Details

I. General information

NPI: 1023941770
Provider Name (Legal Business Name): JOHN WIRICK MD A PROFFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 VICTORY PKWY STE 602
CINCINNATI OH
45206-2837
US

IV. Provider business mailing address

1300 DAYTON AVE
DAYTON KY
41074-1602
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-1539
  • Fax:
Mailing address:
  • Phone: 419-460-1539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN WILLIAM WIRICK
Title or Position: PHYSICIAN
Credential: MD
Phone: 419-460-1539