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NPI Code Detail

MEDICARE: WILHELM C.J. LARSEN M.D.

MEDICARE: WILHELM C.J. LARSEN M.D.
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
1207R00000XInternal Medicine PhysicianME27507FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295773166
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILHELM C.J. LARSEN M.D.
Provider Business Mailing Address
First Line : 1065 NE 125TH STREET
Second Line : SUITE 409
City : NORTH MIAMI
State : FL
Zip : 33161-5834
Country : US
Telephone Number : 888-852-6672
Fax Number : 305-891-4228
Provider Business Practice Location Address
First Line : 10301 HAGEN RANCH ROAD
Second Line : SUITE B6
City : BOYNTON BEACH
State : FL
Zip : 33437-3723
Country : US
Telephone Number : 561-752-9490
Fax Number : 561-752-9491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 01/20/2017

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