Provider Demographics
NPI:1578562369
Name:WILHELM, WILLIAM CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHRISTIAN
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 1:717 STATE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1341
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-877-7907
Practice Address - Fax:814-877-6791
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010269E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01862188OtherNY MEDICAID
PA120701OtherBLUE SHIELD
PA212712OtherUPMC
PAP00170328OtherRR MEDICARE
NY00051996001OtherUNIVERA
PA522600OtherAETNA
OH2221232OtherOH MEDICAID
PA0007249400003Medicaid
PA66434OtherUNISON
PAP000955OtherGATEWAY
PA66434OtherUNISON
PA0007249400003Medicaid