Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR 121 | FL |
N | 222Z00000X | Podiatrist | POR 121 | FL |
N | 224P00000X | Prosthetist | POR 121 | FL |
NPI | 1053484485 |
---|---|
Provider Name | Mr. Joel David Wilch |
First Address | Tampa, FL 33617 |
Second Address | Tampa, FL 33617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |