Provider Demographics
NPI:1306845425
Name:WILKIN, MATTHEW MILES (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MILES
Last Name:WILKIN
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 1:609 FORD ST
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1947
Mailing Address - Country:US
Mailing Address - Phone:419-893-5539
Mailing Address - Fax:419-893-6853
Practice Address - Street 1:609 FORD ST
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1947
Practice Address - Country:US
Practice Address - Phone:419-893-5539
Practice Address - Fax:419-893-6853
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003073213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000135412OtherANTHEM
OH03398OtherPARAMOUNT
OH2121804Medicaid
000000135412OtherANTHEM
OHWI0873491Medicare PIN
OH2121804Medicaid
OH0537250003Medicare NSC
U75023Medicare UPIN
OH480027001Medicare PIN
OH480027002Medicare PIN
OHWI0873493Medicare PIN
OH03398OtherPARAMOUNT