Provider Demographics
NPI:1356533699
Name:JAMES S. WILK, MD
Entity type:Organization
Organization Name:JAMES S. WILK, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-399-8000
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-399-8000
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-399-8000
Practice Address - Fax:303-399-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04015541Medicaid