Provider Demographics
NPI:1588651699
Name:WILKIE, CAREN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:ELIZABETH
Last Name:WILKIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAREN
Other - Middle Name:ELIZABETH
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:201 N CLYDE MORRIS BLVD
Practice Address - Street 2:#100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2724
Practice Address - Country:US
Practice Address - Phone:386-238-3295
Practice Address - Fax:386-238-3273
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47284208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME47284OtherVHN
FL272684000Medicaid
FLME47284OtherDCWO
FLME47284OtherUNITED BENEFITS
FL29029OtherBCBS
FL272684000Medicaid
FL29029OtherBCBS