Provider Demographics
NPI:1982605762
Name:WILHARM, JEFFREY D (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:WILHARM
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 1:800 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-2713
Mailing Address - Country:US
Mailing Address - Phone:319-396-1066
Mailing Address - Fax:319-396-8779
Practice Address - Street 1:3100 E AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2962
Practice Address - Country:US
Practice Address - Phone:319-396-1066
Practice Address - Fax:319-396-8779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA280382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1135020Medicaid
15413OtherBCBS
IA15413Medicare ID - Type Unspecified
IA1135020Medicaid