Provider Demographics
NPI:1033141114
Name:WILKINSON, MICHELLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:E
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3302 S NEW HOPE RD STE 100E
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8317
Mailing Address - Country:US
Mailing Address - Phone:704-879-4936
Mailing Address - Fax:980-225-0492
Practice Address - Street 1:3302 S NEW HOPE RD STE 100E
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8317
Practice Address - Country:US
Practice Address - Phone:704-879-4936
Practice Address - Fax:908-225-0492
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9700808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891049YMedicaid
NC2247988CMedicare PIN
NCG62680Medicare UPIN