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General NPI Number Information
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NPI Number | 1144224700
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Entity Type | Individual
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Provider Name | STEVEN GEORGE WILDERN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 1005 W GREEN ST RM 301
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City | HASTINGS
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State | MI
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Zip | 49058-1729
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Country | US
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Telephone | 269-945-2419
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Fax | 269-945-0357
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Provider Business Mailing Address
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Address Line | 1005 W GREEN ST STE 201
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City | HASTINGS
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State | MI
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Zip | 49058-1726
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Country | US
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Telephone | 269-945-2419
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Fax | 269-945-0357
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | SW039857
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License Number State | MI
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