Individual provider Active NPI

Allan J Wilke, MD

  • Family Medicine Physician
  • Portage, MI
National Provider Identifier
1366404097
Registry record updated Aug 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301043497 Issued in MI
Practice address
1125 E Milham Ave Ste B
Portage, MI 49002-3096
Phone
(269) 312-1446
Fax
(269) 775-1079
NPI assigned
Apr 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C151694 CA
Family Medicine Physician 207Q00000X 4301043497 MI Primary

Addresses

Primary practice location

1125 E Milham Ave Ste B
Portage, MI 49002-3096

Mailing address

PO Box 2174
Kalamazoo, MI 49003-2174
Phone (269) 312-1446

Other practice location 1

1000 Oakland Dr
Kalamazoo, MI 49008-8040
Phone (269) 337-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820000607 MI Practitioner - Family PracticePractitioner - Geriatric Medicine 9133025596 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Michigan State University College of Human Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Serene SolutionsGroup PAC ID 0042641136, 17 clinicians

Practice addresses (Care Compare)

1125 E Milham Ave
Suite B
Portage, MI 49002-3096
Phone (269) 312-1446

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C151694CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center Inc Federally Qualified Health Center (FQHC) Current Accepting new patients
Family Health Center Inc Federally Qualified Health Center (FQHC) CurrentSince Sep 1, 2018 Accepting new patients
Serene Solutions CurrentSince Aug 29, 2021 Accepting new patients
Family Health Center, Inc. Federally Qualified Health Center (FQHC) CurrentSince Sep 1, 2018 Accepting new patients
University of Toledo Physicians LLC Past Accepting new patients

Locations

117 W Paterson St
Kalamazoo, MI 49007

4341 S Westnedge Ave
Ste 1106
Kalamazoo, MI 49008
Phone (269) 312-1446

1125 E Milham Ave
Ste B
Portage, MI 49002
Phone (269) 312-1446

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630195200000",
    "number": "1366404097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2174",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490032174",
            "telephone_number": "269-312-1446",
            "fax_number": "269-775-1079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 E MILHAM AVE STE B",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490023096",
            "telephone_number": "269-312-1446",
            "fax_number": "269-775-1079"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Oakland Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490088040",
            "country_code": "US",
            "telephone_number": "269-337-6500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKE",
        "first_name": "ALLAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2021-08-29",
        "certification_date": "2021-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C151694",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301043497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

Verify at the official NPI Registry.