Provider Demographics
NPI:1346246527
Name:WILHELMUS, SCOTT MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:WILHELMUS
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 1:310 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2718
Mailing Address - Country:US
Mailing Address - Phone:812-996-0337
Mailing Address - Fax:812-996-0223
Practice Address - Street 1:721 W 13TH ST STE 225
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1817
Practice Address - Country:US
Practice Address - Phone:218-996-0337
Practice Address - Fax:812-996-0223
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042083A207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN070006707OtherMEDICARE RAILROAD
IN000000090314OtherANTHEM
IN070006707OtherMEDICARE RAILROAD
IN000000090314OtherANTHEM
IN070006707OtherMEDICARE RAILROAD