Justin David Wildemann, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

57.246367 Issued in OH

Practice address

1029 S Trimble Rd
Mansfield, OH 44906-3427

Phone

(419) 522-3341

NPI assigned

Apr 10, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jwildemann88059@direct.chmca.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Akron Children'S Hospital

  • Children's Hospital
  • Akron, OH
  • NPI 1942465752
  NPD
• Children'S Hospital Medical Center of Akron

  • Home Infusion Agency
  • Akron, OH
  • NPI 1649485848
  NPD (past)
• Children'S Hospital Medical Center of Akron

  • Pediatrics Physician
  • Akron, OH
  • NPI 1841328853
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1235636879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 S TRIMBLE RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449063427",
            "telephone_number": "419-522-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 S TRIMBLE RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449063427",
            "telephone_number": "419-522-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEMANN",
        "first_name": "JUSTIN",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-10",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57.246367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Wickline
• Peter Austin Wiggin, D.P.M.
• Kelly Wilcox
• Sandra Kay Wilcox
• Samantha C Wilde, LSW
• Heather Sheridan Wilds, CMS
• Ashley N Wilford, AGPCNP-BC
• Scot K Wilging, D.C.
• Steven P. Wilkinson
• Kayleigh Willeroy

• Student in an Organized Health Care Education/Training Program in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Student in an Organized Health Care Education/Training Program in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.