Healthcare Provider Details

I. General information

NPI: 1760206643
Provider Name (Legal Business Name): DANIEL J WILHELM MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 SUPERIOR ST
PORT HURON MI
48060-3748
US

IV. Provider business mailing address

1024 SUPERIOR ST
PORT HURON MI
48060-3748
US

V. Phone/Fax

Practice location:
  • Phone: 810-966-0099
  • Fax: 810-696-7339
Mailing address:
  • Phone: 810-966-0099
  • Fax: 810-696-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL WILHELM
Title or Position: MD
Credential: MD
Phone: 810-966-0099