Provider Demographics
NPI:1740201144
Name:WILMOT, CHESTER C (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:C
Last Name:WILMOT
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 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3525 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1965
Practice Address - Country:US
Practice Address - Phone:863-603-6565
Practice Address - Fax:863-904-1961
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97851208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001365900Medicaid
309495OtherAVMED
FL1073806OtherCAREPLUS
FL6501728OtherCIGNA
FL7053917OtherAETNA
FL2700158OtherUNITED
FL78191OtherBCBS
FLP00753965OtherRAILROAD MEDICARE
FL7053917OtherAETNA
FLAK593YMedicare PIN