Provider Demographics
NPI:1205819943
Name:WILKS, MADELINE FRUCHT (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:FRUCHT
Last Name:WILKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LA CLINICA DEL PUEBLO
Mailing Address - Street 2:2831 15TH ST. NW
Mailing Address - City:WASHINTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:US
Mailing Address - Phone:202-462-4788
Mailing Address - Fax:202-667-3706
Practice Address - Street 1:2831 15TH ST. NW
Practice Address - Street 2:LA CLINICA DEL PUEBLO
Practice Address - City:WASHINTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-462-4788
Practice Address - Fax:202-667-3706
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD32450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F92811Medicare UPIN