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General NPI Number Information
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NPI Number | 1609742212
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Entity Type | Organization
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Legal Business Name | ERIE SPINE & PAIN CENTER PC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 4521 ALGONQUIN TRL
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City | GREEN BAY
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State | WI
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Zip | 54313-9529
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Country | US
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Telephone | 814-454-4599
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 ALGONQUIN TRL
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City | GREEN BAY
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State | WI
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Zip | 54313-9529
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Country | US
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Telephone | 814-454-4599
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | THOMAS J WILKINS
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Credential |
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Telephone | 920-621-5674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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