Individual
EDWIN E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
121 POPLAR CT, NEENAH, WI 54956-5013
(920) 722-3494
Mailing address
121 POPLAR CT, NEENAH, WI 54956-5013
(920) 722-3494
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20781
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30131600
—
WI
Enumeration date
09/06/2005
Last updated
07/05/2012
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