Basic Information
| Provider Information | |||||||||
| NPI: | 1578562369 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILHELM | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | CHRISTIAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 717 STATE ST | ||||||||
| Address2: | SUITE 16 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165011341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144807100 | ||||||||
| FaxNumber: | 8144807604 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STATE ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165071427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148777907 | ||||||||
| FaxNumber: | 8148776791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD010269E | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 01862188 | 01 | NY | NY MEDICAID | OTHER | 120701 | 01 | PA | BLUE SHIELD | OTHER | 212712 | 01 | PA | UPMC | OTHER | P00170328 | 01 | PA | RR MEDICARE | OTHER | 00051996001 | 01 | NY | UNIVERA | OTHER | 522600 | 01 | PA | AETNA | OTHER | 2221232 | 01 | OH | OH MEDICAID | OTHER | 0007249400003 | 05 | PA | MEDICAID | 66434 | 01 | PA | UNISON | OTHER | P000955 | 01 | PA | GATEWAY | OTHER |