Provider Demographics
NPI:1518249317
Name:MONDESIR, WILKENS (MD)
Entity type:Individual
Prefix:
First Name:WILKENS
Middle Name:
Last Name:MONDESIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 LAKE WORTH RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3462
Mailing Address - Country:US
Mailing Address - Phone:561-784-7014
Mailing Address - Fax:561-784-7922
Practice Address - Street 1:4849 LAKE WORTH RD STE 201
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3462
Practice Address - Country:US
Practice Address - Phone:561-784-7014
Practice Address - Fax:561-784-7922
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113026207VG0400X, 207V00000X, 207VM0101X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008353100Medicaid
FLHC334ZOtherMEDICARE PTAN
FLHC334OtherMEDICARE PTAN
FLHC334ZMedicare PIN
FLHC334Medicare PIN