Provider Demographics
NPI:1316941958
Name:WILHELMSEN, BRUCE D (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:WILHELMSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W H SMITH BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3763
Mailing Address - Country:US
Mailing Address - Phone:252-757-2663
Mailing Address - Fax:252-317-0829
Practice Address - Street 1:810 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3763
Practice Address - Country:US
Practice Address - Phone:252-757-2663
Practice Address - Fax:252-317-0829
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1274070001OtherDME MAC JURISDICTION C
NC8987396Medicaid
200033972OtherRAILROAD MEDICARE
200033972OtherRAILROAD MEDICARE
211533Medicare ID - Type Unspecified