Provider Demographics
NPI:1447286455
Name:WILLMOTT, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:WILLMOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-757-2927
Mailing Address - Fax:859-341-0203
Practice Address - Street 1:651 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5423
Practice Address - Country:US
Practice Address - Phone:859-757-2927
Practice Address - Fax:859-341-0203
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066185A207RP1001X
KY39473207RS0012X, 207RP1001X
OH35083719208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00935626OtherRAIL ROAD MEDICARE
KY64099054Medicaid
OH2557880Medicaid
KY00954007Medicare PIN
OH2557880Medicaid
KYP400040327Medicare PIN
KYP00935626OtherRAIL ROAD MEDICARE
OHW14149642Medicare PIN
P00716012Medicare PIN