Provider Demographics
NPI:1609090448
Name:WILBUR, RICHARD SLOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SLOAN
Last Name:WILBUR
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 1:985 HAWTHORNE PL
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2217
Mailing Address - Country:US
Mailing Address - Phone:847-234-4977
Mailing Address - Fax:847-234-5294
Practice Address - Street 1:985 HAWTHORNE PL
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2217
Practice Address - Country:US
Practice Address - Phone:847-234-4977
Practice Address - Fax:847-234-5294
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA12298207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine