Provider Demographics
NPI:1922277383
Name:THOMAS J. WILLKE MD, INC
Entity Type:Organization
Organization Name:THOMAS J. WILLKE MD, INC
Other - Org Name:INDIAN SPRINGS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILLKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-863-6222
Mailing Address - Street 1:4125 HAMILTON MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2262
Mailing Address - Country:US
Mailing Address - Phone:513-863-6222
Mailing Address - Fax:513-863-6478
Practice Address - Street 1:4125 HAMILTON MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2262
Practice Address - Country:US
Practice Address - Phone:513-863-6222
Practice Address - Fax:513-863-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.043264207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392338Medicaid
IN20001762AMedicaid
OH0392338Medicaid
OH9374001Medicare PIN