Individual
MR. KHASE A WILKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
715 S COY RD, OREGON, OH 43616-3007
(419) 693-4171
(419) 693-6863
Mailing address
715 S COY RD, OREGON, OH 43616-3007
(419) 693-4171
(419) 693-6863
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
3291
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2517664
—
OH
01
—
CA3437
RR GROUP
OH
01
—
P00157654
RR MEDICARE
OH
Enumeration date
07/28/2005
Last updated
11/15/2007
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