MEDICARE: DR. DOUGLAS CLIFTON WILKERSON 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
1	103TP0814X	Psychoanalysis Psychologist		IL

General Provider Information

NPI Number	:	1639293798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS CLIFTON WILKERSON M. D.

Provider Business Mailing Address
First Line	:	1 E WACKER DR
Second Line	:	SUITE 630
City	:	CHICAGO
State	:	IL
Zip	:	60601-1802
Country	:	US
Telephone Number	:	312-755-0643
Fax Number	:	773-538-8278

Provider Business Practice Location Address
First Line	:	1 E WACKER DR
Second Line	:	SUITE 630
City	:	CHICAGO
State	:	IL
Zip	:	60601-1802
Country	:	US
Telephone Number	:	312-755-0643
Fax Number	:	773-538-8278

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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