Provider Demographics
NPI:1245231216
Name:WILHELM, JOSEPH L (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:WILHELM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CHARLEVOIX DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8186
Mailing Address - Country:US
Mailing Address - Phone:517-337-1668
Mailing Address - Fax:517-622-1205
Practice Address - Street 1:702 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8526
Practice Address - Country:US
Practice Address - Phone:517-332-6523
Practice Address - Fax:517-332-3365
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJW038953207W00000X
MI4301038953207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0800545OtherPHP OF MID MICHIGAN
MI180012514OtherRAILROAD MEDICARE
MI1942390Medicaid
MI200000002400OtherPHP
MI1803307271OtherMICHIGAN BCBS
MI180C36002OtherBCBSM
MI0870545OtherPHP FAMILY CARE
MI180031703OtherRAILROAD MEDICARE
MI1803307271OtherBLUE CARE NETWORK OF MI
MI1803307271OtherBLUE CARE NETWORK OF MI
MI0800545OtherPHP OF MID MICHIGAN
MI200000002400OtherPHP