Provider Demographics
NPI:1295755395
Name:WILD, DANIEL R (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:WILD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6255 SHERIDAN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4836
Mailing Address - Country:US
Mailing Address - Phone:716-857-8666
Mailing Address - Fax:716-857-8944
Practice Address - Street 1:425 ESSJAY RD
Practice Address - Street 2:SUITE 170A
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5782
Practice Address - Country:US
Practice Address - Phone:716-631-3041
Practice Address - Fax:716-631-5380
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-09-21
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Provider Licenses
StateLicense IDTaxonomies
NY137730-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161000580OtherEMPIRE
NY161000580OtherUNITED HEALTHCARE
NY00010189103OtherUNIVERA
NY0905392OtherINDEPENDENT HEALTH
NY161000580OtherMERITAIN
NY161000580OtherNOVA
NY000508251004OtherHEALTH NOW
NY161000580OtherPREFERRED CARE
NYD01427Medicare UPIN
NY161000580OtherPREFERRED CARE