MEDICARE: DR. RICHARD STEPHEN WILKENFELD M.D.

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	208600000X	Surgery Physician	G4747	TX

General Provider Information

NPI Number	:	1588699615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD STEPHEN WILKENFELD M.D.

Provider Business Mailing Address
First Line	:	800 RIVERWOOD CT STE 102
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2824
Country	:	US
Telephone Number	:	936-756-3133
Fax Number	:	936-756-3148

Provider Business Practice Location Address
First Line	:	800 RIVERWOOD CT STE 102
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2824
Country	:	US
Telephone Number	:	936-756-3133
Fax Number	:	936-756-3148

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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