MEDICARE: SWEETIE A WILKINS

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	347C00000X	Private Vehicle		IL

General Provider Information

NPI Number	:	1578365706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SWEETIE A WILKINS

Provider Business Mailing Address
First Line	:	5657 W WASHINGTON BLVD APT 2S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3026
Country	:	US
Telephone Number	:	872-280-4698
Fax Number	:

Provider Business Practice Location Address
First Line	:	5657 W WASHINGTON BLVD APT 2S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3026
Country	:	US
Telephone Number	:	872-280-4698
Fax Number	:

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

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	03/26/2025

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Directions to “ SWEETIE A WILKINS ” Practice Location

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