Provider Demographics
NPI:1386635217
Name:WAKELIN, JOHN KEENE III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEENE
Last Name:WAKELIN
Suffix:III
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 1:5005 ARLINGTON CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2912
Mailing Address - Country:US
Mailing Address - Phone:614-246-6900
Mailing Address - Fax:614-246-6909
Practice Address - Street 1:5005 ARLINGTON CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2912
Practice Address - Country:US
Practice Address - Phone:614-246-6900
Practice Address - Fax:614-246-6909
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 08 0290 W208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7307611Medicare ID - Type Unspecified
H75330Medicare UPIN