Healthcare Provider Details

I. General information

NPI: 1194821892
Provider Name (Legal Business Name): WEST SIDE INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24700 LORAIN RD SUITE 207
NORTH OLMSTED OH
44070-2088
US

IV. Provider business mailing address

PO BOX 451225
WESTLAKE OH
44145-0631
US

V. Phone/Fax

Practice location:
  • Phone: 440-779-5505
  • Fax: 440-779-1342
Mailing address:
  • Phone: 440-808-3700
  • Fax: 440-808-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARGARET G WILBUR
Title or Position: PRESIDENT
Credential: MD
Phone: 440-779-5505