Russell A Wilke, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9764 Issued in SD

Practice address

1205 S Grange Ave
Ste 510
Sioux Falls, SD 57105-0407

Phone

(605) 328-7500

Fax

(605) 328-7599

NPI assigned

Aug 30, 2006

Last updated

Feb 26, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1811007966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S GRANGE AVE",
            "address_2": "STE 510",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050407",
            "telephone_number": "605-328-7500",
            "fax_number": "605-328-7599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKE",
        "first_name": "RUSSELL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "38145",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "45694",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "42291",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ND",
            "license": "12805",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SD",
            "license": "9764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18144",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32289100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1519301",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Wilcoxon, RDN, LN
• Wild Within, PLLC
• James R Wilde, M.D.
• Michael C Wilde, M.D.
• Kelsey Eileen Wildfeuer, CNM
• Richard M. Wilkins, CRNA
• Crystal Lynnann Wilkinson, MSW. CSW, PIP
• Joseph M Wilkinson, DPM
• Will Care Services, LLC (Washington Crossing Assisted Living)
• Morgan Ann Willard, RD

• Internal Medicine Physician in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Internal Medicine Physician in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.