Provider Demographics
NPI:1689674103
Name:WILKE, MICHAEL ORLYN (MA, LP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ORLYN
Last Name:WILKE
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Gender:M
Credentials:MA, LP
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Mailing Address - Street 1:408 SAINT PETER ST
Mailing Address - Street 2:SUITE 429
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1130
Mailing Address - Country:US
Mailing Address - Phone:651-224-0614
Mailing Address - Fax:651-224-5754
Practice Address - Street 1:408 SAINT PETER ST
Practice Address - Street 2:SUITE 429
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1130
Practice Address - Country:US
Practice Address - Phone:651-224-0614
Practice Address - Fax:651-224-5754
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNLP03222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
107383OtherUCARE
65-20851OtherMEDICA
9L760WIOtherBC/BS
R64415Medicare UPIN