Provider Demographics
NPI:1821314436
Name:ANN S WIERWILLE MD INC
Entity Type:Organization
Organization Name:ANN S WIERWILLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WIERWILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-961-7799
Mailing Address - Street 1:3001 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-7799
Mailing Address - Fax:513-961-1530
Practice Address - Street 1:3001 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-7799
Practice Address - Fax:513-961-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35026037102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWI0485591OtherMEDICARE PROVIDER NUMBER
OHWI0485591OtherMEDICARE PROVIDER NUMBER