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General NPI Number Information
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NPI Number | 1861659435
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Entity Type | Organization
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Legal Business Name | BROOKS W. WILKINSON, M.D., LTD
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 30 N MICHIGAN AVE SUITE # 1622
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-541-1571
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Fax | 312-541-1571
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Provider Business Mailing Address
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Address Line | 30 N MICHIGAN AVE SUITE # 1622
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City | CHICAGO
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State | IL
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Zip | 60602-3402
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Country | US
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Telephone | 312-541-1571
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Fax | 312-541-1571
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Authorized Official
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Title or Position | PRESIDENT
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Name | BROOKS WILDING WILKINSON
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Credential | M.D.
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Telephone | 312-541-1571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 036081963
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License Number State | IL
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