Individual
PAUL FORRESTAL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1630 LAFAYETTE RD STE 100, CRAWFORDSVILLE, IN 47933-1091
(765) 364-1611
(765) 361-9627
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01083828A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300041061
—
IN
Enumeration date
03/25/2015
Last updated
01/13/2025
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