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General NPI Number Information
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NPI Number | 1235348228
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Entity Type | Individual
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Provider Name | KIP R WILKINS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 4601 DALE RD 1ST FLOOR SUITE 1A6, DEPARTMENT OF ORTHOPAEDICS
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City | MODESTO
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State | CA
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Zip | 95356-9718
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Country | US
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Telephone | 209-735-6104
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 DALE RD 1ST FLOOR SUITE 1A6, DEPARTMENT OF ORTHOPAEDICS
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City | MODESTO
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State | CA
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Zip | 95356-9718
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Country | US
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Telephone | 209-735-6104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5315013798
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License Number State | MI
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