Provider Demographics
NPI:1366638413
Name:WIKLER FAMILY PRACTICE ASSOCIATES PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WIKLER FAMILY PRACTICE ASSOCIATES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-433-1332
Mailing Address - Street 1:8985 S PECOS RD
Mailing Address - Street 2:4A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7162
Mailing Address - Country:US
Mailing Address - Phone:702-433-1332
Mailing Address - Fax:702-547-4931
Practice Address - Street 1:8985 S PECOS RD
Practice Address - Street 2:4A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7162
Practice Address - Country:US
Practice Address - Phone:702-433-1332
Practice Address - Fax:702-547-4931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-22
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVWCHKYMedicare PIN