Provider Demographics
NPI:1821191271
Name:ABILDGAARD, WILLIAM HARRY JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRY
Last Name:ABILDGAARD
Suffix:JR
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:400 N MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4424
Practice Address - Country:US
Practice Address - Phone:937-438-3376
Practice Address - Fax:937-438-9424
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.135975207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G413700Medicaid
A48548Medicare UPIN
CA00G413700Medicaid