Individual
DR. SEAN TIMOTHY WILLGRUBER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 781-5111
(270) 783-3779
Mailing address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 780-2497
(270) 783-0454
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32326
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191881
ANTHEM
KY
01
—
5151643
AETNA
—
05
—
64323264
—
KY
Enumeration date
06/24/2005
Last updated
10/27/2015
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