Healthcare Provider Details

I. General information

NPI: 1124228101
Provider Name (Legal Business Name): HARRY S WILKS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S MARTIN LUTHER KING JR AVE STE A
CLEARWATER FL
33756-4172
US

IV. Provider business mailing address

1260 S MARTIN LUTHER KING JR AVE STE A
CLEARWATER FL
33756-4172
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-3818
  • Fax: 727-447-7432
Mailing address:
  • Phone: 727-441-3818
  • Fax: 727-447-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME20220
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME20220
License Number StateFL

VIII. Authorized Official

Name: DR. HARRY S WILKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-441-3818