Basic Information
| Provider Information | |||||||||
| NPI: | 1740201144 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILMOT | ||||||||
| FirstName: | CHESTER | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 LAKELAND HILLS BLVD | ||||||||
| Address2: | ATTN: MANAGED CARE DEPT. | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054543 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3525 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338051965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636036565 | ||||||||
| FaxNumber: | 8639041961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | ME97851 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 001365900 | 05 | FL | MEDICAID | 309495 | 01 | AVMED | OTHER | 1073806 | 01 | FL | CAREPLUS | OTHER | 6501728 | 01 | FL | CIGNA | OTHER | 7053917 | 01 | FL | AETNA | OTHER | 2700158 | 01 | FL | UNITED | OTHER | 78191 | 01 | FL | BCBS | OTHER | P00753965 | 01 | FL | RAILROAD MEDICARE | OTHER |