Provider Demographics
NPI:1386697027
Name:COUGHLIN, WILLIAM F (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:COUGHLIN
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 42468
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0468
Mailing Address - Country:US
Mailing Address - Phone:513-965-8041
Mailing Address - Fax:513-965-8091
Practice Address - Street 1:10500 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4402
Practice Address - Country:US
Practice Address - Phone:513-865-1114
Practice Address - Fax:513-965-8091
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010694562085R0202X
OH35-1259952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3358243100Medicaid
KY7100355190Medicaid
OH0131552Medicaid
OHP01487487OtherMEDICARE RAILROAD
IN201296600Medicaid
MI3358243100Medicaid
OHH299720Medicare PIN