Provider Demographics
NPI:1356393201
Name:HABLITZEL, WILLIAM ELWOOD (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELWOOD
Last Name:HABLITZEL
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 1:113 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1312
Mailing Address - Country:US
Mailing Address - Phone:937-544-0400
Mailing Address - Fax:937-544-0407
Practice Address - Street 1:113 E MULBERRY ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1312
Practice Address - Country:US
Practice Address - Phone:937-544-0400
Practice Address - Fax:937-544-0407
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200127790Medicaid
OH110038557OtherRAIL ROAD MEDICARE
KY64862121Medicaid
OH0745028Medicaid
OH0745028Medicaid
OHHA0642094Medicare PIN