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NPI Code Detail

MEDICARE: ROBERT BRENT WILDER

MEDICARE: ROBERT BRENT WILDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician35042804WOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00221626OTHEROHMEDICARE RR-GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2942460636082OTHEROHCARESOURCE

General Provider Information

NPI Number : 1083654198
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT BRENT WILDER
Provider Business Mailing Address
First Line : 3881 E SMITH RD
Second Line :
City : MEDINA
State : OH
Zip : 44256-8771
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18697 BAGLEY RD
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3417
Country : US
Telephone Number : 440-816-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 05/27/2015

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