Provider Demographics
NPI:1780673129
Name:MAUNTEL, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:MAUNTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:741A WESSEL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-3611
Mailing Address - Country:US
Mailing Address - Phone:513-829-2614
Mailing Address - Fax:513-829-0177
Practice Address - Street 1:741A WESSEL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3611
Practice Address - Country:US
Practice Address - Phone:513-829-2614
Practice Address - Fax:513-829-0177
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2019-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH52198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0597902Medicaid
A82764Medicare UPIN
OH0600352Medicare PIN