MEDICARE: DR. LEONARD MARK WILK 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
1	207Q00000X	Family Medicine Physician	MD29044	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1326180688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD MARK WILK MD

Provider Business Mailing Address
First Line	:	2825 E BARNETT RD
Second Line	:	MSS
City	:	MEDFORD
State	:	OR
Zip	:	97504-8332
Country	:	US
Telephone Number	:	541-789-4281
Fax Number	:	541-789-4806

Provider Business Practice Location Address
First Line	:	2841 AVENUE G SUITE
Second Line	:	SUITE 100
City	:	WHITE CITY
State	:	OR
Zip	:	97503-3030
Country	:	US
Telephone Number	:	541-826-5252
Fax Number	:	541-789-5785

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	04/04/2023

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