Individual
BRADFORD MARVIN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
407 E 3RD ST, DULUTH, MN 55805-1950
(218) 786-8364
Mailing address
1340 WALNUT ST, WESTERN SPRINGS, IL 60558-1359
(708) 927-5945
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
04/24/2018
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