Individual
WILLIAM W WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845-1730
(260) 266-5700
(260) 266-5920
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01030636A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641100
ANTHEM
IN
01
—
060070893
RR MEDICARE
IN
05
—
0783915
—
OH
05
—
100085420
—
IN
01
—
P00785636
R.R. MEDICARE
IN
Enumeration date
08/17/2005
Last updated
10/20/2022
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