MEDICARE: BROOKS W. WILKINSON, M.D., LTD

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	261QM0850X	Adult Mental Health Clinic/Center	036081963	IL

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	:	1861659435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKS W. WILKINSON, M.D., LTD

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE # 1622
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-541-1571
Fax Number	:	312-541-1571

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE # 1622
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-541-1571
Fax Number	:	312-541-1571

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BROOKS WILDING WILKINSON
Credential	:	M.D.
Telephone Number	:	312-541-1571

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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Directions to “BROOKS W. WILKINSON, M.D., LTD ” Practice Location

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