Healthcare Provider Details

I. General information

NPI: 1982660668
Provider Name (Legal Business Name): JANICE WILBUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE SUITE 220
MENTOR OH
44060-8713
US

IV. Provider business mailing address

9500 MENTOR AVE SUITE 220
MENTOR OH
44060-8713
US

V. Phone/Fax

Practice location:
  • Phone: 440-357-7100
  • Fax: 440-357-8136
Mailing address:
  • Phone: 440-357-7100
  • Fax: 440-357-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35069849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: