Organization
BLOOMINGTON DERMATOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT M WILHELMUS M.D. (C.E.O.)
(812) 333-0398
Entity
Organization
Contact information
Practice address
2001 E 3RD ST, BLOOMINGTON, IN 47401-7890
(812) 333-0398
(812) 333-0698
Mailing address
2001 E 3RD ST, BLOOMINGTON, IN 47401-7890
(812) 333-0398
(812) 333-0698
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01042083A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
—
01
—
000000090314
ANTHEM
IN
Enumeration date
09/21/2006
Last updated
05/21/2020
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