Provider Demographics
NPI:1194764753
Name:EMLICH, WILLIAM F JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:EMLICH
Suffix:JR
Gender:M
Credentials:DO
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 12626
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-0626
Mailing Address - Country:US
Mailing Address - Phone:614-870-1234
Mailing Address - Fax:614-870-3199
Practice Address - Street 1:4930 W BROAD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1696
Practice Address - Country:US
Practice Address - Phone:614-870-1234
Practice Address - Fax:614-870-3199
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004432207R00000X, 207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0735897Medicaid
OH0699095Medicare PIN
OH4204051Medicare PIN
F13535Medicare UPIN
OH0699096Medicare PIN