MEDICARE: DR. STEVEN WILKS MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	220715	NY
2	207QA0505X	Adult Medicine Physician	D0063195	MD
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	D0063195	MD

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

NPI Number	:	1053311035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN WILKS MD

Provider Business Mailing Address
First Line	:	PO BOX 791372
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-1372
Country	:	US
Telephone Number	:	301-608-8375
Fax Number	:	301-608-3979

Provider Business Practice Location Address
First Line	:	8600 OLD GEORGETOWN RD
Second Line	:	ATTN: MEDICAL STAFF OFFICE/ANGELA SPECK
City	:	BETHESDA
State	:	MD
Zip	:	20814-1422
Country	:	US
Telephone Number	:	301-896-3100
Fax Number	:	301-897-1378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/06/2009

990 GRAND CANYON PKWY , SUITE 418
HOFFMAN ESTATES, IL
60169-1737

Practice Phone: 331-472-8802
Practice Fax: 331-472-8803