Provider Demographics
NPI:1821083866
Name:WILKINSON, MATTHEW BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FRANK SCOTT PKWY W STE 980
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5000
Mailing Address - Country:US
Mailing Address - Phone:618-234-9200
Mailing Address - Fax:618-234-3940
Practice Address - Street 1:2900 FRANK SCOTT PKWY W STE 980
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5000
Practice Address - Country:US
Practice Address - Phone:618-234-9200
Practice Address - Fax:618-234-3940
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107047207P00000X
IL036107047208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821083866Medicaid
IL036107047Medicaid
IL08232205OtherBLUE CROSS BLUE SHIELD
H66569Medicare UPIN
MO1821083866Medicaid
IL036107047Medicaid