Provider Demographics
NPI:1881637395
Name:WILKINSON, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:101 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2151
Mailing Address - Country:US
Mailing Address - Phone:906-486-4431
Mailing Address - Fax:906-485-2504
Practice Address - Street 1:101 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2151
Practice Address - Country:US
Practice Address - Phone:906-486-4431
Practice Address - Fax:906-485-2504
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43057341207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJW057341OtherBLUE SHIELD
010052521OtherRAILROAD RETIREMENT
MI27235310Medicaid
MI27235310Medicaid
D90081Medicare UPIN