Individual
DR. MICHAEL FENTRISS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1555 BARRINGTON RD, SUITE 2300B, HOFFMAN ESTATES, IL 60169-1019
(847) 843-0726
Mailing address
126 E WING ST, #185, ARLINGTON HEIGHTS, IL 60004-6064
(847) 560-4676
(630) 689-5809
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036-060142
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-060142
—
IL
Enumeration date
09/26/2005
Last updated
08/14/2014
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