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General NPI Number Information
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NPI Number | 1164490611
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Entity Type | Individual
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Provider Name | JEFFREY W WILDER MD
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Gender | Male
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 7985 S MACKINAW TRL
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City | CADILLAC
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State | MI
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Zip | 49601-8111
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Country | US
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Telephone | 231-876-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2345
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Country | US
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Telephone | 231-876-7200
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Fax | 231-547-8088
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 65787
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301067907
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License Number State | MI
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