Provider Demographics
NPI:1891737102
Name:WONNELL, DIRK M (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:M
Last Name:WONNELL
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 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1104
Practice Address - Country:US
Practice Address - Phone:513-841-7700
Practice Address - Fax:513-841-7701
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-6608208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0709648Medicaid
OH340011135OtherRAILROAD MEDICARE
KY64955107Medicaid
OH0276946Medicaid
OH340011135OtherRAILROAD MEDICARE
OHA17500Medicare UPIN
KY64955107Medicaid
OH0618057Medicare PIN
OH0618056Medicare PIN
OH0709648Medicaid