Provider Demographics
NPI:1609867597
Name:WILBRANDT, THIERRY H (MD)
Entity Type:Individual
Prefix:DR
First Name:THIERRY
Middle Name:H
Last Name:WILBRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5912 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6300
Mailing Address - Country:US
Mailing Address - Phone:317-247-1335
Mailing Address - Fax:317-247-1442
Practice Address - Street 1:5912 W 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6300
Practice Address - Country:US
Practice Address - Phone:317-247-1335
Practice Address - Fax:317-247-1442
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033835207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN316780Medicare PIN
IND87676Medicare UPIN