Provider Demographics
NPI:1932125093
Name:WILKINS, JAY M (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:240 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3115
Mailing Address - Country:US
Mailing Address - Phone:920-887-1151
Mailing Address - Fax:920-887-3353
Practice Address - Street 1:240 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3115
Practice Address - Country:US
Practice Address - Phone:920-887-1151
Practice Address - Fax:920-887-3353
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI46586207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00134868OtherRAIL ROAD MEDICARE
WI0120OtherJOHN DEERE HEALTH PLAN
391156156OtherTAX ID
WI3457900Medicaid
39115615618OtherUNITY HMO
13792OtherDEAN CARE HMO
WI46250OtherNETWORK HEALTH PLAN
WI2001237OtherPHYSICIANS PLUS HMO
391156156OtherTAX ID
39115615618OtherUNITY HMO