Individual
MICHELLE MARGARITA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
27103
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
27103
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271039
—
SC
Enumeration date
03/21/2007
Last updated
06/23/2021
Update your record
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