Provider Demographics
NPI:1770693038
Name:WILKERSON, CATHERINE E (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:WILKERSON
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 1:1405 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2960
Mailing Address - Country:US
Mailing Address - Phone:734-646-3953
Mailing Address - Fax:
Practice Address - Street 1:1405 CULVER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2960
Practice Address - Country:US
Practice Address - Phone:734-646-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICW4301057196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16987OtherM-CARE
MIC64246OtherHAP
MI4731587Medicaid
MIOH16245010Medicare ID - Type Unspecified
MIC64246OtherHAP