# ISAIAH WILSON MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427665561
- **Authorized official:** ISAIAH WILSON MD (CEO)
- **Authorized official phone:** (517) 862-2565

## Contact information

- **Practice address:** 1200 W ALBANY ST, BROKEN ARROW, OK 74012-8146
- **Practice address phone:** (918) 744-2338
- **Mailing address:** PO BOX 1383, JENKS, OK 74037-1383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2020
- **Last updated:** 09/23/2020