Provider Demographics
NPI:1427041565
Name:DONAHUE, WILLIAM ELLIS JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ELLIS
Last Name:DONAHUE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 ROCKSIDE RD STE B
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2700
Practice Address - Country:US
Practice Address - Phone:216-459-8616
Practice Address - Fax:216-459-0373
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002283213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH350891OtherSTAYWELL HEALTH/WELLCARE
OH000000137360OtherUNICARE
OH0598974Medicaid
OH000000564755OtherANTHEM BLUE CROSS BLUE SHIELD
OH000000137360OtherANTHEM BCBS
OH000000564725OtherANTHEM BLUE CROSS BLUE SHIELD
OH000000137360OtherANTHEM BCBS
OH000000564755OtherANTHEM BLUE CROSS BLUE SHIELD
OH0598974Medicaid
OH0568284Medicare PIN
OH350891OtherSTAYWELL HEALTH/WELLCARE