Individual
CRAIG JEFFREY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2605 N LEBANON ST, LEBANON, IN 46052-1476
(765) 485-8000
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01048372A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
01048372A
IN
208M00000X
Hospitalist Physician
Primary
01048372A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200195130
—
IN
Enumeration date
12/05/2005
Last updated
10/11/2023
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