Basic Information
| Provider Information | |||||||||
| NPI: | 1356434856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILKENS | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 CENTURY BLVD STE 120 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372143693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153466213 | ||||||||
| FaxNumber: | 6153466225 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 STONECREST PKWY STE 230 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152239935 | ||||||||
| FaxNumber: | 6158915046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD0000026875 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | MD0000026875 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3885402 | 05 | TN | MEDICAID | 64064397 | 05 | KY | MEDICAID |