Provider Demographics
NPI:1689663627
Name:PILAKOWSKI, CLEVE RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:CLEVE
Middle Name:RICHARD
Last Name:PILAKOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 BOB BILLINGS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3998
Mailing Address - Country:US
Mailing Address - Phone:910-795-6029
Mailing Address - Fax:
Practice Address - Street 1:5100 BOB BILLINGS PKWY
Practice Address - Street 2:STE 100
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3998
Practice Address - Country:US
Practice Address - Phone:910-795-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00657213E00000X
KS12-00392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10372OtherWELLMARK PROVIDER NUMBER
IA1158147Medicaid
IA10372OtherWELLMARK PROVIDER NUMBER
IA1158147Medicaid