Basic Information
| Provider Information | |||||||||
| NPI: | 1588612949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILK | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176216333 | ||||||||
| FaxNumber: | 3176219676 | ||||||||
| Practice Location | |||||||||
| Address1: | 9669 E 146TH ST | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460605004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176219926 | ||||||||
| FaxNumber: | 3176219676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01063091A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000658367 | 01 | IN | ANTHEM | OTHER | 000000523092 | 01 | IN | ANTHEM | OTHER |