MEDICARE: DR. MICHELLE E WILKINSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	9700808	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033141114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE E WILKINSON MD

Provider Business Mailing Address
First Line	:	3302 S NEW HOPE RD STE 100E
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-8317
Country	:	US
Telephone Number	:	704-879-4936
Fax Number	:	980-225-0492

Provider Business Practice Location Address
First Line	:	3302 S NEW HOPE RD STE 100E
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-8317
Country	:	US
Telephone Number	:	704-879-4936
Fax Number	:	908-225-0492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/25/2017

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