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General NPI Number Information
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NPI Number | 1659322154
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Entity Type | Individual
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Provider Name | JEFFREY WILLIAM WIKE MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 792 N MAIN ST STE 200A
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-1673
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Country | US
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Telephone | 315-458-8700
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Fax | 315-701-1075
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Provider Business Mailing Address
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Address Line | 1001 W FAYETTE ST SUITE 400
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City | SYRACUSE
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State | NY
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Zip | 13204-2859
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Country | US
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Telephone | 315-472-1488
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Fax | 315-476-1792
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 239475
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License Number State | NY
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