Provider Demographics
NPI:1346457934
Name:WILBER, JEREMY J (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:WILBER
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 1:65 AIRPORT PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1439
Mailing Address - Country:US
Mailing Address - Phone:317-807-0268
Mailing Address - Fax:317-528-8115
Practice Address - Street 1:65 AIRPORT PKWY STE 114
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1439
Practice Address - Country:US
Practice Address - Phone:317-807-0268
Practice Address - Fax:317-528-8115
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065140A207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200916960Medicaid
IN339250F9Medicare PIN