Provider Demographics
NPI:1154018695
Name:WILKES, ERIC LINNELL JR
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LINNELL
Last Name:WILKES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20931 RECHER AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2441
Mailing Address - Country:US
Mailing Address - Phone:216-575-8796
Mailing Address - Fax:
Practice Address - Street 1:20931 RECHER AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-2441
Practice Address - Country:US
Practice Address - Phone:216-575-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty