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NPI Code Detail

MEDICARE: C H WILKINSON PHYSICIAN NETWORK

MEDICARE: C H WILKINSON PHYSICIAN NETWORK
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1659528347
Entity Type Code : Organization
Provider Name (Legal Business Name) : C H WILKINSON PHYSICIAN NETWORK
Provider Business Mailing Address
First Line : 1700 WEST LOOP SOUTH
Second Line : SUITE 400B
City : HOUSTON
State : TX
Zip : 77027-3005
Country : US
Telephone Number : 713-277-2700
Fax Number :
Provider Business Practice Location Address
First Line : 1701 FM 646 EAST
Second Line :
City : LEAGUE CITY
State : TX
Zip : 77573-4968
Country : US
Telephone Number : 281-337-5430
Fax Number :
Authorized Official
Title or Position : VP RETAIL OPERATIONS
Name : RONALD RETKOWSKI
Credential :
Telephone Number : 713-371-8545
Provider Enumeration Date : 08/25/2008
Last Update Date : 08/25/2008

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Directions to “C H WILKINSON PHYSICIAN NETWORK ” Practice Location

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