Provider Demographics
NPI:1114396009
Name:WIKE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 3850
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2883
Mailing Address - Country:US
Mailing Address - Phone:312-642-9816
Mailing Address - Fax:
Practice Address - Street 1:676 N MICHIGAN AVE
Practice Address - Street 2:SUITE 3850
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2883
Practice Address - Country:US
Practice Address - Phone:312-642-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385.004104363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical