Provider Demographics
NPI:1457312134
Name:WANTZ, ANITA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:J
Last Name:WANTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2009
Mailing Address - Country:US
Mailing Address - Phone:937-382-1616
Mailing Address - Fax:937-382-7877
Practice Address - Street 1:1184 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2009
Practice Address - Country:US
Practice Address - Phone:937-382-1616
Practice Address - Fax:937-382-7877
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0702770Medicaid
OH0702770Medicaid
OHWA4159421Medicare PIN
OHA17544Medicare UPIN