Provider Demographics
NPI:1124057690
Name:WILKINSON, WILLIAM SCOTT (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1117
Mailing Address - Country:US
Mailing Address - Phone:248-646-4082
Mailing Address - Fax:
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5033
Practice Address - Country:US
Practice Address - Phone:248-334-4931
Practice Address - Fax:248-858-3993
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406185207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4326472OtherAETNA PIN
MI4749812Medicaid
MI1806316611OtherBCBS OF MICHIGAN PIN
MI2584455Medicaid
MI2584455Medicaid