Organization
KATHRYN A. S. WILSON DO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN A. WILSON DO (OWNER)
(937) 748-9051
Entity
Organization
Contact information
Practice address
32 S RICHARDS RUN, SPRINGBORO, OH 45066-8003
(937) 748-9051
(937) 748-9054
Mailing address
70 SOUTHFIELD CT, SPRINGBORO, OH 45066-9268
(800) 357-5728
(937) 291-2962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150287
UNITED MINE WORKERS
OH
05
—
2346572
—
OH
01
—
CK6330
RAILROAD MEDICARE
OH
Enumeration date
08/31/2006
Last updated
04/22/2008
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