Provider Demographics
NPI:1861659435
Name:BROOKS W. WILKINSON, M.D., LTD
Entity Type:Organization
Organization Name:BROOKS W. WILKINSON, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:WILDING
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-541-1571
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE # 1622
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-541-1571
Mailing Address - Fax:312-541-1571
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE # 1622
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-541-1571
Practice Address - Fax:312-541-1571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081963261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081963Medicaid
IL975560Medicare PIN
ILF25258Medicare UPIN