Provider Demographics
NPI:1245473842
Name:C H WILKINSON PHYSICIAN NETWORK
Entity type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2208
Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3005
Mailing Address - Country:US
Mailing Address - Phone:713-277-2222
Mailing Address - Fax:
Practice Address - Street 1:6441 HIGHSTAR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-779-6400
Practice Address - Fax:713-779-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty