Provider Demographics
NPI:1154395606
Name:WILNER, JOEL M (DPM)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:WILNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 HARKLE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4751
Mailing Address - Country:US
Mailing Address - Phone:505-983-7393
Mailing Address - Fax:505-983-7249
Practice Address - Street 1:665 HARKLE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4751
Practice Address - Country:US
Practice Address - Phone:505-983-7393
Practice Address - Fax:505-983-7249
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM178213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97553824Medicaid
826480034OtherRAILROAD MEDICARE
NM54346Medicaid
NM97553824Medicaid
NM54346Medicaid