MEDICARE: DR. JEFFREY D WILHARM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	28038	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15413	OTHER		BCBS

General Provider Information

NPI Number	:	1982605762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D WILHARM MD

Provider Business Mailing Address
First Line	:	800 1ST ST NW
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52405-2713
Country	:	US
Telephone Number	:	319-396-1066
Fax Number	:	319-396-8779

Provider Business Practice Location Address
First Line	:	3100 E AVE NW
Second Line	:	SUITE 101
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52405-2962
Country	:	US
Telephone Number	:	319-396-1066
Fax Number	:	319-396-8779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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