1841287414 NPI number — DR. KENNETH R WILHELM DPM

Table of content: DR. KENNETH R WILHELM DPM (NPI 1841287414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841287414 NPI number — DR. KENNETH R WILHELM DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILHELM
Provider First Name:
KENNETH
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1841287414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 REDWOOD SQUARE CTR
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20121-4265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-996-3000
Provider Business Mailing Address Fax Number:
703-229-1152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 REDWOOD SQUARE CTR
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121-4265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-996-3000
Provider Business Practice Location Address Fax Number:
703-229-1152
Provider Enumeration Date:
09/29/2005

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: 213ES0131X , with the licence number:  0103000986 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009302531 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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