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NPI Code Detail

MEDICARE: GARY A WILEY MSED

MEDICARE: GARY A WILEY MSED
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
1101YP2500XProfessional CounselorE.0002032OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000347075OTHEROHANTHEM BLUE CROSS PIN

General Provider Information

NPI Number : 1437177326
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY A WILEY MSED
Provider Business Mailing Address
First Line : 2525 E 22ND ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-3202
Country : US
Telephone Number : 216-459-9827
Fax Number : 216-459-9821
Provider Business Practice Location Address
First Line : 3518 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1951
Country : US
Telephone Number : 216-459-9827
Fax Number : 216-459-9821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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Directions to “ GARY A WILEY MSED” Practice Location

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