Provider Demographics
NPI:1235348228
Name:WILKINS, KIP R (MD)
Entity Type:Individual
Prefix:DR
First Name:KIP
Middle Name:R
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4601 DALE RD
Mailing Address - Street 2:1ST FLOOR SUITE 1A6, DEPARTMENT OF ORTHOPAEDICS
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9718
Mailing Address - Country:US
Mailing Address - Phone:209-735-6104
Mailing Address - Fax:
Practice Address - Street 1:4601 DALE RD
Practice Address - Street 2:1ST FLOOR SUITE 1A6, DEPARTMENT OF ORTHOPAEDICS
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9718
Practice Address - Country:US
Practice Address - Phone:209-735-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5315013798207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery