Healthcare Provider Details

I. General information

NPI: 1174128615
Provider Name (Legal Business Name): KARRY R. WILKES, M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3666 PAXTON AVE
CINCINNATI OH
45208-1568
US

IV. Provider business mailing address

3666 PAXTON AVE
CINCINNATI OH
45208-1568
US

V. Phone/Fax

Practice location:
  • Phone: 513-871-1183
  • Fax:
Mailing address:
  • Phone: 513-871-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE CAMPBELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 513-871-1183