Individual
MR. MARK ANDREW WILK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2011 W. DAVIS ROAD, PHOENIX, AZ 85023-7802
(602) 942-6421
(602) 564-2840
Mailing address
2011 W. DAVIS ROAD, PHOENIX, AZ 85023-7802
(602) 942-6421
(602) 564-2840
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
ROC 165112
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436908
—
AZ
05
—
631029
—
AZ
Enumeration date
04/26/2007
Last updated
07/09/2007
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