Individual
GERALD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1004 N CLARK ST, CHICAGO, IL 60610-2941
(312) 291-9435
Mailing address
1004 N CLARK ST, CHICAGO, IL 60610-2941
(312) 291-9435
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
011253222
IL
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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