MEDICARE: DR. DONALD E WILD MD

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
1	207X00000X	Orthopaedic Surgery Physician	4301027945	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1598766883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD E WILD MD

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR LBBY J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 ELLIOTT DR
Second Line	:	SUITE 301
City	:	YPSILANTI
State	:	MI
Zip	:	48197-8634
Country	:	US
Telephone Number	:	734-572-4500
Fax Number	:	734-572-4529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/14/2019

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Directions to “ DR. DONALD E WILD MD” Practice Location

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