Provider Demographics
NPI:1871630509
Name:J S WILKENFELD MD & ASSOCIATES
Entity Type:Organization
Organization Name:J S WILKENFELD MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZING OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANGELOSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-559-6929
Mailing Address - Street 1:PO BOX 690129
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0129
Mailing Address - Country:US
Mailing Address - Phone:877-787-9677
Mailing Address - Fax:855-697-2447
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2317207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082007801Medicaid
DG6808OtherRAILROAD MEDICARE
TX00D22VOtherBCBS
TX082007801Medicaid