Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
612 N ANDOVER RD, ANDOVER, KS 67002-9778
(316) 733-6618
(316) 733-5299
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25289
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041801
BCBS
KS
01
—
100842
HPK
KS
01
—
11084898
MULTIPLAN
KS
01
—
16949
COVENTRY
KS
01
—
2807
PHS
KS
Enumeration date
08/06/2006
Last updated
07/16/2007
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