Provider Demographics
NPI:1588699615
Name:WILKENFELD, RICHARD STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEPHEN
Last Name:WILKENFELD
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 1:800 RIVERWOOD CT STE 102
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2824
Mailing Address - Country:US
Mailing Address - Phone:936-756-3133
Mailing Address - Fax:936-756-3148
Practice Address - Street 1:800 RIVERWOOD CT STE 102
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2824
Practice Address - Country:US
Practice Address - Phone:936-756-3133
Practice Address - Fax:936-756-3148
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4747208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27581Medicare UPIN
TX00TX40Medicare ID - Type Unspecified