Provider Demographics
NPI:1780851758
Name:WIMBISCUS, MOLLY MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:MICHELLE
Last Name:WIMBISCUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:P57
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-8674
Mailing Address - Fax:216-444-9054
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:P57
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-8674
Practice Address - Fax:216-444-9054
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH570124232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry