Basic Information
| Provider Information | |||||||||
| NPI: | 1588613160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILBUR | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24700 LORAIN RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407795505 | ||||||||
| FaxNumber: | 4407791342 | ||||||||
| Practice Location | |||||||||
| Address1: | 24700 LORAIN RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440702088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407795505 | ||||||||
| FaxNumber: | 4407791342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35048238 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00705999 | 01 | OH | RRCARE | OTHER | 0517373 | 05 | OH | MEDICAID |