Provider Demographics
NPI:1992946115
Name:C H WILKINSON PHYSICIAN NETWORK
Entity type:Organization
Organization Name:C H WILKINSON PHYSICIAN NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2208
Mailing Address - Street 1:3717 HWY 3, STE A1
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8024
Mailing Address - Country:US
Mailing Address - Phone:281-534-3983
Mailing Address - Fax:
Practice Address - Street 1:3717 HWY 3, STE A1
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8024
Practice Address - Country:US
Practice Address - Phone:281-534-3983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty