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Individual

KENNETH WILHELM JR.

Active
Sole proprietor

Provider details

NPI number
Gender
Man

Contact information

Practice address
4400 E FLAMINGO AVE, NAMPA, ID 83687-9203
(208) 288-4970
(208) 288-4990
Mailing address
217 W GEORGIA AVE, SUITE 115, NAMPA, ID 83686-6811
(208) 463-3000
(208) 463-3034

Taxonomy

Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
M9346
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010151677
BLUE SHEILD
ID
01
75721
BLUE CROSS
ID
Enumeration date
10/26/2005
Last updated
07/08/2007
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