Provider Demographics
NPI:1447394911
Name:STREETER, WILBERT CALVIN (DO)
Entity type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:CALVIN
Last Name:STREETER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 S 625 W
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:IN
Mailing Address - Zip Code:46571-9030
Mailing Address - Country:US
Mailing Address - Phone:260-593-2602
Mailing Address - Fax:260-593-3985
Practice Address - Street 1:2275 S 625 W
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:IN
Practice Address - Zip Code:46571-9030
Practice Address - Country:US
Practice Address - Phone:260-593-2602
Practice Address - Fax:260-593-3985
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000543A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine