Provider Demographics
NPI:1073827366
Name:KENNETH G.WILHELM M.D. P.C.
Entity Type:Organization
Organization Name:KENNETH G.WILHELM M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-434-2490
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE R-5017
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-2490
Mailing Address - Fax:734-434-8855
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE R-5017
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-2490
Practice Address - Fax:734-434-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty