Individual
ROBERT BRENT WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18697 BAGLEY RD, MIDDLEBURG HEIGHTS, OH 44130-3417
(440) 816-8000
Mailing address
3881 E SMITH RD, MEDINA, OH 44256-8771
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35042804W
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0427710
—
OH
01
—
942460636082
CARESOURCE
OH
01
—
P00221626
MEDICARE RR-GA
OH
Enumeration date
06/07/2006
Last updated
05/27/2015
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