Provider Demographics
NPI:1639293798
Name:WILKERSON, DOUGLAS CLIFTON (M D)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CLIFTON
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E WACKER DR
Mailing Address - Street 2:SUITE 630
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1802
Mailing Address - Country:US
Mailing Address - Phone:312-755-0643
Mailing Address - Fax:773-538-8278
Practice Address - Street 1:1 E WACKER DR
Practice Address - Street 2:SUITE 630
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1802
Practice Address - Country:US
Practice Address - Phone:312-755-0643
Practice Address - Fax:773-538-8278
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis