Healthcare Provider Details

I. General information

NPI: 1457268617
Provider Name (Legal Business Name): RAUL WIKKELING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-5813
US

IV. Provider business mailing address

1431 WASHINGTON BLVD APT 819
DETROIT MI
48226-1721
US

V. Phone/Fax

Practice location:
  • Phone: 202-525-4855
  • Fax:
Mailing address:
  • Phone: 313-597-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: