1093718306 NPI number — DR. DENNIS J WIWI M.D.

Table of content: DR. DENNIS J WIWI M.D. (NPI 1093718306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093718306 NPI number — DR. DENNIS J WIWI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIWI
Provider First Name:
DENNIS
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093718306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 READING RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45202-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-721-3200
Provider Business Mailing Address Fax Number:
513-639-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 MERCY HEALTH BLVD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45211-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-481-5100
Provider Business Practice Location Address Fax Number:
513-481-3880
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35147310 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160039066 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200072950 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311575051033 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 64961857 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0554403 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000021064 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 990479 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0720620 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 288098 . This is a "AMERIGROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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