Provider Demographics
NPI:1134108384
Name:WILBERG, CARL WALTER (DO)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:WALTER
Last Name:WILBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5959 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2921
Mailing Address - Country:US
Mailing Address - Phone:231-845-6261
Mailing Address - Fax:231-845-6261
Practice Address - Street 1:1352 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9318
Practice Address - Country:US
Practice Address - Phone:231-723-8363
Practice Address - Fax:231-398-2680
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006968207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI180E300140OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI180E310290OtherBCBS OF MICHIGAN
MI4921536Medicaid
MI4921518Medicaid
MIP00349763OtherRAILROAD MEDICARE
MI4921563Medicaid
MI180E300150OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI180E310290OtherBCBS OF MICHIGAN
MI4921518Medicaid