Provider Demographics
NPI:1750371985
Name:WILES, JOHN B (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:WILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:B
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:STE 140
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-893-0221
Mailing Address - Fax:716-893-0225
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:STE 140
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-893-0221
Practice Address - Fax:716-893-0225
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00645432Medicaid
00010189401OtherUNIVERA HEALTHCARE
1708903OtherINDEPENDENT HEALTH
000508227003OtherHEALTH NOW BLUE CROSS SHI
010696OtherGROUP HEALTH INCORPORATED
14332BMedicare ID - Type Unspecified
NY00645432Medicaid