Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-5640
Mailing address
75 FRANCIS ST, BOSTON, MA 02115-6110
(617) 732-5640
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
200001030
NC
207P00000X
Emergency Medicine Physician
Primary
MD20836
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1268U
BLUE CROSS
NC
05
—
891268U
—
NC
Enumeration date
05/20/2006
Last updated
07/03/2024
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