Healthcare Provider Details

I. General information

NPI: 1730123746
Provider Name (Legal Business Name): NEIL L WILKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/07/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 CO- 105
PALMER LAKE CO
80133
US

IV. Provider business mailing address

2920 DIVISION ST
SAINT JOSEPH MI
49085-2437
US

V. Phone/Fax

Practice location:
  • Phone: 719-602-0914
  • Fax:
Mailing address:
  • Phone: 269-982-7844
  • Fax: 269-982-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301081313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: