Provider Demographics
NPI:1720839970
Name:WILKIE, OWEN
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:WILKIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15546 GOLDFINCH CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-7014
Mailing Address - Country:US
Mailing Address - Phone:561-634-5808
Mailing Address - Fax:
Practice Address - Street 1:15546 GOLDFINCH CIR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:FL
Practice Address - Zip Code:33470-7014
Practice Address - Country:US
Practice Address - Phone:561-634-5808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies