Provider Demographics
NPI:1184604910
Name:WILHELM, DONALD L (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:WILHELM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-556-5191
Mailing Address - Fax:573-556-5757
Practice Address - Street 1:2221 BAGNELL DAM BLVD
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8603
Practice Address - Country:US
Practice Address - Phone:573-635-5264
Practice Address - Fax:573-556-5757
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118054207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00063177OtherMEDICARE RAILROAD
MO409684OtherHEALTHLINK
MO122237OtherBCBS
MODA5571OtherRAILROAD GROUP
D99982Medicare UPIN