Provider Demographics
NPI:1255429494
Name:WILKINS, WARREN MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MATTHEW
Last Name:WILKINS
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 1:450 MAYO DR
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1211
Mailing Address - Country:US
Mailing Address - Phone:309-344-2831
Mailing Address - Fax:309-344-2014
Practice Address - Street 1:450 MAYO DR
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1211
Practice Address - Country:US
Practice Address - Phone:309-344-2831
Practice Address - Fax:309-344-2014
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-77270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL014885OtherHEALTH ALLIANCE INS.
036077270OtherBLUE CROSS BLUE SHIELD
ILCM5868OtherRAILROAD MEDICARE
300016168OtherRAILROAD MEDICARE
920-000-334OtherRAILROAD MEDICARE
IL036077270Medicaid
036077270OtherBLUE CROSS BLUE SHIELD
IL036077270Medicaid