Provider Demographics
NPI:1497923304
Name:CHRISTOPHER D. WILHELM
Entity Type:Organization
Organization Name:CHRISTOPHER D. WILHELM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-828-3300
Mailing Address - Street 1:1080 KIRTS BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4853
Mailing Address - Country:US
Mailing Address - Phone:248-828-3300
Mailing Address - Fax:248-828-8423
Practice Address - Street 1:1080 KIRTS BLVD STE 700
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-828-3300
Practice Address - Fax:248-828-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICW045808302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106300681Medicare PIN