Basic Information
| Provider Information | |||||||||
| NPI: | 1194764753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMLICH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12626 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432120626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148701234 | ||||||||
| FaxNumber: | 6148703199 | ||||||||
| Practice Location | |||||||||
| Address1: | 4930 W BROAD ST | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148701234 | ||||||||
| FaxNumber: | 6148703199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34-004432 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 34-004432 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RI0008X | 34-004432 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology |
ID Information
| ID | Type | State | Issuer | Description | 0735897 | 05 | OH | MEDICAID |