Provider Demographics
NPI:1154529709
Name:WILHELM, CHELLE P (MD)
Entity type:Individual
Prefix:DR
First Name:CHELLE
Middle Name:P
Last Name:WILHELM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHELLE
Other - Middle Name:R
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 LAKELAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4829
Mailing Address - Country:US
Mailing Address - Phone:601-360-0270
Mailing Address - Fax:601-354-2619
Practice Address - Street 1:1513 LAKELAND DR STE 101
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4829
Practice Address - Country:US
Practice Address - Phone:601-360-0270
Practice Address - Fax:601-354-2619
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20909207RP1001X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03309314Medicaid
MS428075YJ5DMedicare PIN
MS03309314Medicaid