Provider Demographics
NPI:1679754642
Name:WILKINSON, JULIA BLAIZE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:BLAIZE
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N. WINFIELD RD.
Mailing Address - Street 2:STE 103
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-933-4487
Mailing Address - Fax:630-933-2009
Practice Address - Street 1:25 N. WINFIELD RD.
Practice Address - Street 2:STE 103
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-933-4487
Practice Address - Fax:630-933-2009
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135153207RC0000X, 2086S0129X
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400163486OtherMEDICARE INDIVIDUAL
LA1007692Medicaid
IL206147OtherMEDICARE GROUP PTAN