Provider Demographics
NPI:1942321138
Name:WILKES, CRAIG A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:WILKES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2288
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2228
Mailing Address - Country:US
Mailing Address - Phone:916-435-5200
Mailing Address - Fax:916-435-5231
Practice Address - Street 1:9692 SWAN LAKE DR
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746-6605
Practice Address - Country:US
Practice Address - Phone:916-435-5200
Practice Address - Fax:916-435-5231
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3432213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0221480001Medicare NSC
CAP00430432Medicare PIN
CA000E34320Medicare PIN