Provider Demographics
NPI:1750380481
Name:WILMER, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:WILMER
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 1:595 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8908
Mailing Address - Country:US
Mailing Address - Phone:614-823-8500
Mailing Address - Fax:614-823-8501
Practice Address - Street 1:595 COPELAND MILL RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8908
Practice Address - Country:US
Practice Address - Phone:614-823-8500
Practice Address - Fax:614-823-8501
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060681207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0816264Medicaid
OH4112324Medicare PIN
OH4112325Medicare PIN
OH4112321Medicare PIN
OH0816264Medicaid
OH4112322Medicare PIN
OH4112323Medicare PIN
OH0816264Medicaid
OH4112324Medicare PIN
OH4112325Medicare PIN
OHWI4112325Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH4112323Medicare PIN