Provider Demographics
NPI:1750381380
Name:WILKE, KRISTIN MARGARET (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARGARET
Last Name:WILKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E SONTERRA BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3972
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-402-2868
Practice Address - Street 1:300 E SONTERRA BLVD STE 320
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3972
Practice Address - Country:US
Practice Address - Phone:210-872-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144969601Medicaid