Provider Demographics
NPI:1366404097
Name:WILKE, ALLAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:WILKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2174
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49003-2174
Mailing Address - Country:US
Mailing Address - Phone:269-312-1446
Mailing Address - Fax:269-775-1079
Practice Address - Street 1:1125 E MILHAM AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3096
Practice Address - Country:US
Practice Address - Phone:269-312-1446
Practice Address - Fax:269-775-1079
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC151694207Q00000X
MI4301043497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E54122Medicare UPIN