Wilt, Robert Joe

Wilt, Robert Joe is an individual health care provider with primary practice located at 374 E Grand Ave Sw Student Health Center Mailcode 6740, Carbondale IL 62901. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Wilt, Robert Joe can be contacted via phone (618) 453-3311.

Contact Information

Primary practice address
374 E Grand Ave Sw Student Health Center Mailcode 6740 Carbondale IL 62901
Phone: (618) 453-3311
Fax: (618) 453-4479
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036072277 Illinois

Profile Details

NPI number 1720103682
LBN Legal business name Wilt, Robert Joe
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 20th, 2007
Last updated Jul 28th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720103682 NPPES
Illinois Other 659580 MEDICARE GROUP
Illinois MEDICAID 036072277 MEDICARE GROUP
Illinois Other 371359450 MEDICARE GROUP
Illinois Other CB3700 MEDICARE GROUP
Illinois Other 10007459 MEDICARE GROUP
Illinois Other 144160 MEDICARE GROUP

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