Healthcare Provider Details

I. General information

NPI: 1295918001
Provider Name (Legal Business Name): MICHAEL DAVID WILHELM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HOSPITAL DR
SACRAMENTO CA
95823-5403
US

IV. Provider business mailing address

3300 DOUGLAS BLVD SUITE 200
ROSEVILLE CA
95661-3844
US

V. Phone/Fax

Practice location:
  • Phone: 916-423-3000
  • Fax:
Mailing address:
  • Phone: 916-782-5705
  • Fax: 916-782-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: