Provider Demographics
NPI:1619997046
Name:WILFLEY, WILLIAM A JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:WILFLEY
Suffix:JR
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 1:2400 PINE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7803
Mailing Address - Country:US
Mailing Address - Phone:715-847-2022
Mailing Address - Fax:715-843-1003
Practice Address - Street 1:2400 PINE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7803
Practice Address - Country:US
Practice Address - Phone:715-847-2022
Practice Address - Fax:715-843-1003
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044986208600000X
WI60454208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8427437Medicaid
OR241389Medicaid
WA8943482OtherCRIME VICTIMS
WA217046OtherLABOR & IND.
WI100031344Medicaid
P00380119OtherRAILROAD MEDICARE
WA8427437Medicaid
I34629Medicare UPIN
WA8943482OtherCRIME VICTIMS