MEDICARE: BRADON J WILHELMI 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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	40545	KY

General Provider Information

NPI Number	:	1417943549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADON J WILHELMI M.D.

Provider Business Mailing Address
First Line	:	401 E CHESTNUT ST
Second Line	:	SUITE 710
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-583-8303
Fax Number	:	502-584-0302

Provider Business Practice Location Address
First Line	:	401 E CHESTNUT ST
Second Line	:	SUITE 710
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5700
Country	:	US
Telephone Number	:	502-583-8303
Fax Number	:	502-584-0302

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/19/2011

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