Healthcare Provider Details

I. General information

NPI: 1861196511
Provider Name (Legal Business Name): JOHN WILHELM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 04/04/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC09 5030 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-2719
US

IV. Provider business mailing address

MSC09 5030 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
81731-6722
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: