# DR. KEITH A WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1164424743
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 35-052784 | OH | Yes |

## Other

- **Enumeration date:** 08/12/2005
- **Last updated:** 01/14/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000126322 | ANTHEM | OH |
| 01 | — | 0095849000 | MEDICAID | WV |
| 05 | — | 0624695 | — | OH |
| 01 | — | 0800328 | UNITED HEALTHCARE | OH |
| 01 | — | 180011155 | RAILROAD MEDICARE | OH |
| 01 | — | 4096251 | AETNA | OH |
| 01 | — | 438220 | KEYSTONE | OH |
| 01 | — | 82799 | QUALCHOICE | OH |
| 01 | — | Z52784 | SUMMACARE | OH |