Provider Demographics
NPI:1790703130
Name:WILKINSON, DI (MD)
Entity Type:Individual
Prefix:DR
First Name:DI
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3101 CHANDLER RD
Mailing Address - Street 2:#101
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4954
Mailing Address - Country:US
Mailing Address - Phone:918-687-4411
Mailing Address - Fax:918-687-4448
Practice Address - Street 1:3101 CHANDLER RD
Practice Address - Street 2:#101
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4954
Practice Address - Country:US
Practice Address - Phone:918-687-4411
Practice Address - Fax:918-687-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK8414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100149870DMedicaid
OK100149870DMedicaid