Provider Demographics
NPI:1003865080
Name:WILHELM, SUSAN R (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:WILHELM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:MERITER ATRIUM
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-5970
Mailing Address - Fax:608-417-5966
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:MERITER ATRIUM
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-417-5970
Practice Address - Fax:608-417-5966
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI769-023363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI970010936OtherRAILRAOD MEDICARE
WI42949700Medicaid
WI3962OtherDEAN HEALTH INSURANCE
WI42949700Medicaid
WI970010936OtherRAILRAOD MEDICARE