Individual
KEITH D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2142 N COVE BLVD, TOLEDO, OH 43606-3895
(419) 291-4000
Mailing address
3103 EXECUTIVE PKWY, SUITE 200, TOLEDO, OH 43606-1312
(419) 474-4064
(419) 472-2772
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35-031930
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0350178
—
OH
01
—
300013461
RR MEDICARE
OH
Enumeration date
09/15/2005
Last updated
01/17/2012
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