Provider Demographics
NPI:1164777587
Name:WILKE, LINDSEY WAKEFIELD (DPM)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:WAKEFIELD
Last Name:WILKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 EL CAMINO REAL # 311B
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1205
Mailing Address - Country:US
Mailing Address - Phone:760-580-6733
Mailing Address - Fax:442-224-7956
Practice Address - Street 1:1512 GREEN OAK RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8740
Practice Address - Country:US
Practice Address - Phone:760-580-6733
Practice Address - Fax:442-224-7956
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00000000000213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery