MEDICARE: DR. JEFFREY W WILDER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	65787	MN
2	207V00000X	Obstetrics & Gynecology Physician	4301067907	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	160055213	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160B41011	OTHER	MI	BCBS MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	383445481	OTHER	MI	TAX ID

General Provider Information

NPI Number	:	1164490611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY W WILDER MD

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2345
Country	:	US
Telephone Number	:	231-876-7200
Fax Number	:	231-547-8088

Provider Business Practice Location Address
First Line	:	7985 S MACKINAW TRL
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8111
Country	:	US
Telephone Number	:	231-876-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/16/2026

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Directions to “ DR. JEFFREY W WILDER MD” Practice Location

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