MEDICARE: MICHAEL WILKES

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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7583	OTHER	MN	LICENSE#

General Provider Information

NPI Number	:	1639380413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILKES

Provider Business Mailing Address
First Line	:	6439 HUMBOLDT AVE S
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-1215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 RUTH ST N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4337
Country	:	US
Telephone Number	:	651-288-9616
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	01/26/2026

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Directions to “ MICHAEL WILKES ” Practice Location

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