Provider Demographics
NPI:1174904395
Name:WILKINS, MARK ALLRED (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLRED
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W MICHIGAN ST
Mailing Address - Street 2:CL 626
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5209
Mailing Address - Country:US
Mailing Address - Phone:317-278-2689
Mailing Address - Fax:
Practice Address - Street 1:2900 12TH AVE N STE 205W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7520
Practice Address - Country:US
Practice Address - Phone:406-254-0707
Practice Address - Fax:406-254-0709
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11018416A207L00000X
MT73206207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology