Provider Demographics
NPI:1235139551
Name:WILKINSON, KHASE A (DPM)
Entity Type:Individual
Prefix:MR
First Name:KHASE
Middle Name:A
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 1:715 S COY RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3007
Mailing Address - Country:US
Mailing Address - Phone:419-693-4171
Mailing Address - Fax:419-693-6863
Practice Address - Street 1:715 S COY RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3007
Practice Address - Country:US
Practice Address - Phone:419-693-4171
Practice Address - Fax:419-693-6863
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3291213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00157654OtherRR MEDICARE
OH2517664Medicaid
OHCA3437OtherRR GROUP
OHCA3437OtherRR GROUP
OH2517664Medicaid