MEDICARE: DR. LAMONT WILKINS 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	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1346872876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAMONT WILKINS MD

Provider Business Mailing Address
First Line	:	2492 DERBYSHIRE RD APT 8
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-5217
Country	:	US
Telephone Number	:	586-709-3867
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N WOLFE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0005
Country	:	US
Telephone Number	:	586-709-3867
Fax Number	:

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

Provider Enumeration Date	:	02/12/2020
Last Update Date	:	02/12/2020

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