Provider Demographics
NPI:1205813763
Name:GUL, WAHEED (MD)
Entity Type:Individual
Prefix:
First Name:WAHEED
Middle Name:
Last Name:GUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 WYNDHAM DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8539
Mailing Address - Country:US
Mailing Address - Phone:937-334-1965
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:SUITE 210
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-8530
Practice Address - Fax:740-779-8539
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37905207R00000X
OH35.088347207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64073877Medicaid
IN200509200Medicaid
KY000000311898OtherANTHEM BCBS
OH2670382Medicaid
KY0614715Medicare PIN
KY000000311898OtherANTHEM BCBS
OH2670382Medicaid
IN200509200Medicaid
KY64073877Medicaid
H96365Medicare UPIN
KY0654812Medicare PIN