Provider Demographics
NPI:1184626814
Name:MIDIAN, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MIDIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:
Other - Last Name:MIDIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2417 MANCHESTER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3522
Mailing Address - Country:US
Mailing Address - Phone:330-896-0900
Mailing Address - Fax:330-848-3325
Practice Address - Street 1:2417 MANCHESTER RD
Practice Address - Street 2:SUITE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3522
Practice Address - Country:US
Practice Address - Phone:330-896-0900
Practice Address - Fax:330-848-3325
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH046828207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0709264Medicaid
OH463753994OtherTAX ID
OH0709264Medicaid
OH463753994OtherTAX ID