Organization
IAN G. WILKOFSKY MDPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN G WILKOFSKY MD (OWNER)
(972) 420-1776
Entity
Organization
Contact information
Practice address
1234 FM 407, STE 100, NORTH LAKE, TX 76226
(972) 420-1776
(972) 221-8685
Mailing address
5000 LONG PRAIRIE RD, SUITE 100, FLOWER MOUND, TX 75028-2783
(972) 420-1776
(972) 221-8685
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
P5905
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045074
MEDICARE
TX
01
—
7366270001
MEDICARE NSC
TX
Enumeration date
02/12/2015
Last updated
09/01/2021
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