Randall M. Wilk, MD, DDS, PHD, Apmc

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

022962 Issued in LA

Legal business name

RANDALL M. WILK, MD, DDS, PHD, APMC

Practice address

120 Meadowcrest St, #300
Gretna, LA 70056

Phone

(504) 362-6135

Fax

(504) 362-6134

NPI assigned

May 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Randall M. Wilk, MDNPI 1669578944

Title

Owner

Phone

(504) 362-6135

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randall Mark Wilk, MD DDS PHD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Gretna, LA
  • NPI 1669578944

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD Authorized official
• Richard Tipery Akin, M.D., D.D.S.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Baton Rouge, LA
  • NPI 1194996637
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1285849166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST, #300",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "70056",
            "telephone_number": "504-362-6135",
            "fax_number": "504-362-6134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MEADOWCREST ST, #300",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "70056",
            "telephone_number": "504-362-6135",
            "fax_number": "504-362-6134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDALL M. WILK, MD, DDS, PHD, APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-13",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "WILK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-362-6135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "4669",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "LA",
            "license": "022962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1890197",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ariel Tremaine Ragas
• Jeaneca Railey, CIT
• Ramy Corporation
• Phillip L Reed, M.D.
• Whitney Elaine Reed I
• Emily Reilly
• Renal Treatment Centers-Southeast, LP.
• Responsibility House, Inc.

• Oral & Maxillofacial Surgery (D.M.D.) in Gretna, LA
• Providers in Gretna, LA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.