Provider Demographics
NPI:1174611974
Name:WILKES, KARRY RUEDEBUSCH (MD)
Entity type:Individual
Prefix:DR
First Name:KARRY
Middle Name:RUEDEBUSCH
Last Name:WILKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3666 PAXTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1568
Mailing Address - Country:US
Mailing Address - Phone:513-871-0684
Mailing Address - Fax:513-871-0705
Practice Address - Street 1:3666 PAXTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1568
Practice Address - Country:US
Practice Address - Phone:513-871-0684
Practice Address - Fax:513-871-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.092220OtherOHIO STATE LICENSE
KY42680OtherKY LICNSE