Provider Demographics
NPI:1811958176
Name:WILKE, CATHERINE S (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:S
Last Name:WILKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12348 OLD TESSON RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2251
Mailing Address - Country:US
Mailing Address - Phone:314-467-3900
Mailing Address - Fax:
Practice Address - Street 1:12348 OLD TESSON RD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2251
Practice Address - Country:US
Practice Address - Phone:314-467-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO102564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811958176Medicaid
MO110179942OtherRAILROAD MEDICARE
MO110179942OtherRAILROAD MEDICARE
MO967635280Medicare PIN