Provider Demographics
NPI:1912418443
Name:CRAIG WILKES
Entity Type:Organization
Organization Name:CRAIG WILKES
Other - Org Name:CRAIG WILKES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-983-8555
Mailing Address - Street 1:PO BOX 2288
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-8288
Mailing Address - Country:US
Mailing Address - Phone:916-435-5200
Mailing Address - Fax:916-435-5231
Practice Address - Street 1:6000 FAIRWAY DR STE 18
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4246
Practice Address - Country:US
Practice Address - Phone:916-435-5200
Practice Address - Fax:916-435-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3432213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty