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Individual

DR. HALLIE J WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
114 N MAIN ST, ITHACA, MI 48847
(989) 875-4166
(989) 875-3600
Mailing address
PO BOX 730, 406 E ELM ST, CARSON CITY, MI 48811
(989) 584-3131
(989) 584-6734

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101011981
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3381288
MI
Enumeration date
02/22/2006
Last updated
07/08/2007
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