Basic Information
| Provider Information | |||||||||
| NPI: | 1205813763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUL | ||||||||
| FirstName: | WAHEED | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2631 WYNDHAM DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454318539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373341965 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4439 STATE ROUTE 159 | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407798530 | ||||||||
| FaxNumber: | 7407798539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37905 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 35.088347 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 64073877 | 05 | KY | MEDICAID | 200509200 | 05 | IN | MEDICAID | 000000311898 | 01 | KY | ANTHEM BCBS | OTHER | 2670382 | 05 | OH | MEDICAID |