Provider Demographics
NPI:1578568168
Name:WILKIE, KIMBERLY A (DPM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WILKIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MARYLAND RD
Mailing Address - Street 2:STE 30
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1700
Mailing Address - Country:US
Mailing Address - Phone:215-659-4400
Mailing Address - Fax:215-659-5931
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:STE 30
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1700
Practice Address - Country:US
Practice Address - Phone:215-659-4400
Practice Address - Fax:215-659-5931
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003312L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012685400002Medicaid
480018665OtherPALMETTOGBA-RRMEDICARE
480018665OtherPALMETTOGBA-RRMEDICARE
T88985Medicare UPIN
1076770001Medicare NSC
577451GS7Medicare PIN