Provider Demographics
NPI:1194710145
Name:WILMOT, DAVID E (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:WILMOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7393 WINDRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8801
Mailing Address - Country:US
Mailing Address - Phone:317-408-3056
Mailing Address - Fax:317-203-1104
Practice Address - Street 1:1411 S GREEN ST
Practice Address - Street 2:SUITE 130
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2049
Practice Address - Country:US
Practice Address - Phone:317-858-4610
Practice Address - Fax:317-858-4620
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01038693A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100134200AMedicaid
IN100134200AMedicaid
INE82075Medicare UPIN