| Randall M. Wilk, Md, Dds, Phd, Apmc | |
|
120 Meadowcrest St, #300 Gretna LA 70056 | |
| (504) 362-6135 | |
| (504) 362-6134 |
| Full Name | Randall M. Wilk, Md, Dds, Phd, Apmc |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 120 Meadowcrest St, #300, Gretna, Louisiana |
| Authorized Official Name and Position | Randall M. Wilk (OWNER) |
| Authorized Official Contact | 5043626135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall M. Wilk, Md, Dds, Phd, Apmc 120 Meadowcrest St, #300 Gretna LA 70056 Ph: (504) 362-6135 | Randall M. Wilk, Md, Dds, Phd, Apmc 120 Meadowcrest St, #300 Gretna LA 70056 Ph: (504) 362-6135 |
| NPI Number | 1285849166 |
|---|---|
| Provider Enumeration Date | 05/13/2007 |
| Last Update Date | 10/11/2013 |
| Medicare PECOS PAC ID | 2264530625 |
|---|---|
| Medicare Enrollment ID | O20070607000630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285849166 | NPI | - | NPPES |
| 1890197 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4669 (Louisiana) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | 022962 (Louisiana) | Primary |
| Provider Name | Randall M Wilk |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1669578944 PECOS PAC ID: 0749295632 Enrollment ID: I20060214000423 |
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