Provider Demographics
NPI:1407847668
Name:WILKERSON, MICHAEL DEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEE
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 N FREEDOM ROAD CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7219
Mailing Address - Country:US
Mailing Address - Phone:806-355-9447
Mailing Address - Fax:806-356-9251
Practice Address - Street 1:1900 MEDI PARK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2104
Practice Address - Country:US
Practice Address - Phone:806-355-9447
Practice Address - Fax:806-356-9251
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9067208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126320402Medicaid
TX86X715Medicare PIN