Individual
JONATHAN W WILDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7926 PRESTON HWY, SUITE 208, LOUISVILLE, KY 40219-3848
(502) 968-3010
(502) 968-0035
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27444
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000050941
ANTHEM / NCMA
—
01
—
000023035A
HUMANA / NCMA
—
01
—
008890
SIHO / NCMA
—
01
—
1055818
PASSPORT / NCMA
—
01
—
110161205
MEDICARE RAILROAD
KY
01
—
1198266
CHA / NCMA
—
01
—
2433815000
PASSPORT ADVANTAGE / NCMA
—
05
—
64274442
—
KY
01
—
7107709003
CIGNA / NCMA
—
Enumeration date
04/26/2006
Last updated
04/26/2023
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