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General NPI Number Information
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NPI Number | 1275545311
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Entity Type | Organization
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Legal Business Name | NORTHWEST FOOTCARE, LLC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 1693 SW CHANDLER AVE STE 280
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City | BEND
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State | OR
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Zip | 97702
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Country | US
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Telephone | 541-385-7129
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Fax | 541-385-7138
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Provider Business Mailing Address
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Address Line | 1693 SW CHANDLER AVE STE 280
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City | BEND
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State | OR
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Zip | 97702
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Country | US
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Telephone | 541-385-7129
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Fax | 541-385-7138
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | BRYAN D WILHELM
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Credential | DPM
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Telephone | 541-385-7129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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