Healthcare Provider Details

I. General information

NPI: 1346246527
Provider Name (Legal Business Name): SCOTT MICHAEL WILHELMUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 NEWTON ST
JASPER IN
47546-1020
US

IV. Provider business mailing address

310 W 6TH ST
JASPER IN
47546-2718
US

V. Phone/Fax

Practice location:
  • Phone: 812-556-5084
  • Fax: 812-556-5086
Mailing address:
  • Phone: 812-996-0337
  • Fax: 812-996-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01042083A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number01042083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: