Healthcare Provider Details

I. General information

NPI: 1144585878
Provider Name (Legal Business Name): WHILISER DRIVE EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEAL ZICK RD
WILLARD OH
44890-9287
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 419-964-5000
  • Fax: 419-935-9506
Mailing address:
  • Phone: 469-401-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSS RONAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 469-401-2386