Provider Demographics
NPI:1881757466
Name:WILKINS, LEE (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
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:ISU THOMAS B THIELEN STUDENT HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-2260
Mailing Address - Country:US
Mailing Address - Phone:515-294-5801
Mailing Address - Fax:515-294-7180
Practice Address - Street 1:ISU THOMAS B THIELEN STUDENT HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011-2260
Practice Address - Country:US
Practice Address - Phone:515-294-5801
Practice Address - Fax:515-294-7180
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02715OtherBCBS
IA0033159Medicaid
E73656Medicare UPIN