Individual
MR. MICHAEL THOMAS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO LPO FAAOP
Contact information
Practice address
2711 CARTWRIGHT RD, MISSOURI CITY, TX 77459-2602
(281) 403-0107
Mailing address
2711 CARTWRIGHT RD, MISSOURI CITY, TX 77459-2602
(281) 403-0107
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
584
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z05085353
—
TX
Enumeration date
05/22/2007
Last updated
07/08/2007
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