Individual
JOHN WILCKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-3870
Mailing address
PO BOX 64664, BALTIMORE, MD 21264-4664
(410) 550-0453
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
D52636
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
699930100
—
MD
Enumeration date
07/05/2006
Last updated
02/20/2013
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