Provider Demographics
NPI:1518079367
Name:WILHELM, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:WILHELM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1257
Mailing Address - Country:US
Mailing Address - Phone:727-391-9690
Mailing Address - Fax:727-397-8821
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1257
Practice Address - Country:US
Practice Address - Phone:727-391-9690
Practice Address - Fax:727-397-8821
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0027169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D58727Medicare UPIN
FL79275Medicare PIN