Individual
MR. SHAWN P WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1969 W HART RD, BELOIT, WI 53511
(608) 758-7215
(608) 758-3216
Mailing address
1446 N RANDALL AVE, JANESVILLE, WI 53545-1122
(608) 758-7215
(608) 758-3216
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
031093
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31583400
—
WI
Enumeration date
08/24/2006
Last updated
11/03/2020
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