=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174257695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN DAVID WILKINSON AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2022
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5700 MONROE ST UNIT 310
-----------------------------------------------------
City | SYLVANIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43560-2768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-578-7557
-----------------------------------------------------
Fax | 419-539-6335
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3072 CARSKADDON AVE APT 309
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43606-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-499-9642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | A.02382
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------