Provider Demographics
NPI:1619389475
Name:WILK, SEBASTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:
Last Name:WILK
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 1:535 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1593
Mailing Address - Country:US
Mailing Address - Phone:716-376-2223
Mailing Address - Fax:716-376-2349
Practice Address - Street 1:OLEAN MEDICAL GROUP
Practice Address - Street 2:535 MAIN ST
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-376-2223
Practice Address - Fax:716-376-2349
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2019-10-11
Deactivation Date:2015-01-07
Deactivation Code:
Reactivation Date:2015-05-13
Provider Licenses
StateLicense IDTaxonomies
NY297852207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty