Provider Demographics
NPI:1982931044
Name:WILKINSON, SUSAN ZELDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ZELDA
Last Name:WILKINSON
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 1:450 S WILLARD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6744
Mailing Address - Country:US
Mailing Address - Phone:928-634-9573
Mailing Address - Fax:928-634-0135
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 115
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-634-5551
Practice Address - Fax:928-634-5604
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42190207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ478813Medicaid
AZ42190OtherAZ MEDICAL LICENSE
AZ478813Medicaid