Healthcare Provider Details

I. General information

NPI: 1568482115
Provider Name (Legal Business Name): STEPHEN VINCENT WILKINSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 RIVERSIDE AVE STE C
FORT COLLINS CO
80524-4366
US

IV. Provider business mailing address

1355 RIVERSIDE AVE STE C
FORT COLLINS CO
80524-4366
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-4620
  • Fax: 970-484-4645
Mailing address:
  • Phone: 970-484-4620
  • Fax: 970-484-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD.0000808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: