Provider Demographics
NPI:1376546234
Name:WILKE, MARK STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:WILKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3316 W 66TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2544
Mailing Address - Country:US
Mailing Address - Phone:763-525-0363
Mailing Address - Fax:763-525-0369
Practice Address - Street 1:9900 13TH AVENUE N
Practice Address - Street 2:STE 2A
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-5035
Practice Address - Country:US
Practice Address - Phone:763-525-0363
Practice Address - Fax:763-525-0369
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN37708207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN048218800Medicaid
MN048218800Medicaid
F89612Medicare UPIN