1245231216 NPI number — JOSEPH L WILHELM MD

Table of content: JOSEPH L WILHELM MD (NPI 1245231216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245231216 NPI number — JOSEPH L WILHELM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILHELM
Provider First Name:
JOSEPH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245231216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 CHARLEVOIX DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND LEDGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48837-8186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-337-1668
Provider Business Mailing Address Fax Number:
517-622-1205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 W LAKE LANSING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-332-6523
Provider Business Practice Location Address Fax Number:
517-332-3365
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  JW038953 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: 4301038953 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0800545 . This is a "PHP OF MID MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180012514 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1942390 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200000002400 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1803307271 . This is a "MICHIGAN BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180C36002 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0870545 . This is a "PHP FAMILY CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 180031703 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1803307271 . This is a "BLUE CARE NETWORK OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com