Individual
DR. MARLA KAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1522 S 5TH ST, SPRINGFIELD, IL 62703-2549
(217) 522-3622
(217) 522-3046
Mailing address
1522 S 5TH ST, SPRINGFIELD, IL 62703-2549
(217) 522-3622
(217) 522-3046
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016-004880
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1626545
BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/14/2006
Last updated
03/25/2011
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