Healthcare Provider Details

I. General information

NPI: 1205769924
Provider Name (Legal Business Name): EMILY WILK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AUTO CLUB DR STE 300
DEARBORN MI
48126-2619
US

IV. Provider business mailing address

5250 AUTO CLUB DR STE 300
DEARBORN MI
48126-2619
US

V. Phone/Fax

Practice location:
  • Phone: 313-724-9000
  • Fax:
Mailing address:
  • Phone: 313-724-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704305952
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: