Individual
KIM L WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E SUPERIOR ST STE L401, DULUTH, MN 55802
(218) 249-7960
(218) 249-7997
Mailing address
1001 E SUPERIOR ST STE L401, DULUTH, MN 55802-2207
(218) 249-7960
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2534
SD
207R00000X
Internal Medicine Physician
Primary
65959
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000743
—
SD
Enumeration date
05/06/2006
Last updated
12/04/2020
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