Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D10783 | MN |
NPI | 1013051028 |
---|---|
Provider Name | William Louis Wilkie |
First Address | Fridley, MN 55432-3100 |
Second Address | Fridley, MN 55432-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |