Provider Demographics
NPI:1093850117
Name:WILKINSON, MICHAEL PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2050
Mailing Address - Country:US
Mailing Address - Phone:307-237-3668
Mailing Address - Fax:307-237-1180
Practice Address - Street 1:2233 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2050
Practice Address - Country:US
Practice Address - Phone:307-237-3668
Practice Address - Fax:307-237-1180
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY106213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112211800Medicaid
WYU61983Medicare UPIN
WYW304149Medicare PIN
WY1217700001Medicare NSC