Provider Demographics
NPI:1770591794
Name:WILKINS, TAMMY HUBER (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:HUBER
Last Name:WILKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:HUBER-WILKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1095 NIMITZVIEW DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4392
Mailing Address - Country:US
Mailing Address - Phone:513-231-3030
Mailing Address - Fax:513-231-4793
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-853-1300
Practice Address - Fax:513-451-4118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350654212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0142983Medicaid
OH35.065421OtherOHIO LICENSE
265062000OtherMAGELLAN
OH0142983Medicaid
OH31146640000OtherBWC
F73083Medicare UPIN
OH0142983Medicaid