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NPI Code Detail

MEDICARE: DR. KERRI S WILTCHIK MD

MEDICARE: DR. KERRI S WILTCHIK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology PhysicianA55973CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CB219807OTHERCAMEDICARE ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043203730
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KERRI S WILTCHIK MD
Provider Business Mailing Address
First Line : 117 WEST BUNNY AVENUE
Second Line :
City : SANTA MARIA
State : CA
Zip : 93458-2805
Country : US
Telephone Number : 805-347-2100
Fax Number : 805-347-2114
Provider Business Practice Location Address
First Line : 220 SOUTH PALISADE DRIVE
Second Line : SUITE 201
City : SANTA MARIA
State : CA
Zip : 93454-8903
Country : US
Telephone Number : 805-347-2100
Fax Number : 805-347-2114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 10/23/2015

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Directions to “ DR. KERRI S WILTCHIK MD” Practice Location

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