Healthcare Provider Details

I. General information

NPI: 1194645192
Provider Name (Legal Business Name): KARL WILHELM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 SHADELAND STATION WAY
INDIANAPOLIS IN
46256-3925
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 317-912-4620
  • Fax: 317-912-4621
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06007107A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: