Healthcare Provider Details

I. General information

NPI: 1609742212
Provider Name (Legal Business Name): ERIE SPINE & PAIN CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 ALGONQUIN TRL
GREEN BAY WI
54313-9529
US

IV. Provider business mailing address

4521 ALGONQUIN TRL
GREEN BAY WI
54313-9529
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-4599
  • Fax:
Mailing address:
  • Phone: 814-454-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS J WILKINS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 920-621-5674