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Individual

DR. JAMES MICHAEL WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 961-3300
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4266
(262) 787-4026

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
45183-020
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
34337800
WI
01
P00384887
RAIL ROAD MEDICARE
Enumeration date
12/02/2005
Last updated
02/15/2009
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