| Robert Brent Wilder, | |
|
18697 Bagley Rd, Middleburg Heights, OH 44130-3417 | |
| (440) 816-8000 | |
| Not Available |
| Full Name | Robert Brent Wilder |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 18697 Bagley Rd, Middleburg Heights, Ohio |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083654198 | NPI | - | NPPES |
| 0427710 | Medicaid | OH | |
| 942460636082 | Other | OH | CARESOURCE |
| P00221626 | Other | OH | MEDICARE RR-GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 35042804W (Ohio) | Primary |
| Entity Name | Emergency Professional Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093762353 PECOS PAC ID: 7214832435 Enrollment ID: O20040511000864 |
| Mailing Address | Practice Location Address |
|---|---|
| Robert Brent Wilder, 3881 E Smith Rd, Medina, OH 44256-8771 Ph: () - | Robert Brent Wilder, 18697 Bagley Rd, Middleburg Heights, OH 44130-3417 Ph: (440) 816-8000 |
James Jos Rybak, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Phillip Stout, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Ibrahim Hasan, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Michelle Ashley Fallon, DO Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 | |
Nicole Wadsworth, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 7123 Pearl Rd, Middleburg Heights, OH 44130 Phone: 440-842-7990 Fax: 440-842-8835 | |
Angel Ronda, DO Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 18697 Bagley Rd, Middleburg Heights, OH 44130 Phone: 440-816-8000 |