Individual
PAUL G WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7910 E WASHINGTON ST, SUITE 200, INDIANAPOLIS, IN 46219-6803
(317) 355-7171
(317) 355-9022
Mailing address
12 KING JOHN DR, INDIANAPOLIS, IN 46227-2397
(317) 782-4820
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01029579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000312971
ANTHEM
IN
05
—
100072620
—
IN
01
—
P00261923
RR MEDICARE
IN
Enumeration date
07/25/2006
Last updated
07/01/2021
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