Provider Demographics
NPI:1124228101
Name:HARRY S WILKS MD PA
Entity Type:Organization
Organization Name:HARRY S WILKS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-441-3818
Mailing Address - Street 1:1260 S MARTIN LUTHER KING JR AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4172
Mailing Address - Country:US
Mailing Address - Phone:727-441-3818
Mailing Address - Fax:727-447-7432
Practice Address - Street 1:1260 S MARTIN LUTHER KING JR AVE STE A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4172
Practice Address - Country:US
Practice Address - Phone:727-441-3818
Practice Address - Fax:727-447-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20220207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI206Medicare PIN