Provider Demographics
NPI:1336585306
Name:WLB INTERVENTIONAL, LLC
Entity Type:Organization
Organization Name:WLB INTERVENTIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-794-1006
Mailing Address - Street 1:1500 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1619
Mailing Address - Country:US
Mailing Address - Phone:419-794-1006
Mailing Address - Fax:419-794-1008
Practice Address - Street 1:1500 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1619
Practice Address - Country:US
Practice Address - Phone:419-794-1006
Practice Address - Fax:419-794-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty