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NPI Code Detail

MEDICARE: DR. KELVIN JAMES WILEY M.D.

MEDICARE: DR. KELVIN JAMES WILEY M.D.
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
1174400000XSpecialist23431SC
2207R00000XInternal Medicine PhysicianME111390FL

Other Identifiers

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

General Provider Information

NPI Number : 1194810481
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELVIN JAMES WILEY M.D.
Provider Business Mailing Address
First Line : 1650 MARGARET ST
Second Line : STE 302
City : JACKSONVILLE
State : FL
Zip : 32204-3868
Country : US
Telephone Number : 803-718-6251
Fax Number :
Provider Business Practice Location Address
First Line : 4201 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-1431
Country : US
Telephone Number : 803-718-6251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 01/12/2026

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