Ryan M. Wilke, D.o., A Medical Corporation | |
11878 Avenue Of Industry San Diego CA 92128 | |
(760) 317-5797 | |
(760) 739-5792 |
Full Name | Ryan M. Wilke, D.o., A Medical Corporation |
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Speciality | Psychiatry & Neurology |
Location | 11878 Avenue Of Industry, San Diego, California |
Authorized Official Name and Position | Ryan Michael-david Wilke (OWNER/PRESIDENT) |
Authorized Official Contact | 7603175797 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Ryan M. Wilke, D.o., A Medical Corporation Po Box 1770 La Mesa CA 91944-1770 Ph: (760) 317-5797 | Ryan M. Wilke, D.o., A Medical Corporation 11878 Avenue Of Industry San Diego CA 92128 Ph: (760) 317-5797 |
NPI Number | 1386177251 |
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Provider Enumeration Date | 04/07/2017 |
Last Update Date | 06/20/2018 |
Medicare PECOS PAC ID | 5890061006 |
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Medicare Enrollment ID | O20171016001724 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386177251 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Ryan M Wilke |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1104186899 PECOS PAC ID: 6305135781 Enrollment ID: I20160525002099 |
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