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General NPI Number Information
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NPI Number | 1750371985
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Entity Type | Individual
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Provider Name | JOHN B WILES MD
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2625 HARLEM RD STE 140
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4031
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Country | US
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Telephone | 716-893-0221
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Fax | 716-893-0225
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Provider Business Mailing Address
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Address Line | 2625 HARLEM RD STE 140
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-4031
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Country | US
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Telephone | 716-893-0221
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Fax | 716-893-0225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 132618
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License Number State | NY
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Legacy Identifiers
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Identifier #1
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Identifier Code | 00645432
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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Identifier #2
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Identifier Code | 00010189401
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | UNIVERA HEALTHCARE
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Identifier #3
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Identifier Code | 1708903
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | INDEPENDENT HEALTH
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Identifier #4
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Identifier Code | 000508227003
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | HEALTH NOW BLUE CROSS SHI
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Identifier #5
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Identifier Code | 010696
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | GROUP HEALTH INCORPORATED
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 00010189401
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | UNIVERA HEALTHCARE
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Identifier #2
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Identifier Code | 000508227003
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | HEALTH NOW BLUE CROSS SHI
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Identifier #3
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Identifier Code | 00645432
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Identifier Type | MEDICAID
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Identifier State | NY
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Identifier Issuer |
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Identifier #4
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Identifier Code | 010696
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | GROUP HEALTH INCORPORATED
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Identifier #5
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Identifier Code | 1708903
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | INDEPENDENT HEALTH
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