1588651699 NPI number — CAREN ELIZABETH WILKIE MD

Table of content: (NPI 1235737586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588651699 NPI number — CAREN ELIZABETH WILKIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKIE
Provider First Name:
CAREN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAINES
Provider Other First Name:
CAREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588651699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9671
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32120-9671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-676-7130
Provider Business Mailing Address Fax Number:
386-676-7125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-238-3295
Provider Business Practice Location Address Fax Number:
386-238-3273
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME47284 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME47284 . This is a "VHN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272684000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME47284 . This is a "DCWO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME47284 . This is a "UNITED BENEFITS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29029 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 272684000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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