Individual
MR. NATHAN G WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
790 N. HWY 67, FLORISSANT, MO 63031-5108
(314) 972-1442
(314) 972-1533
Mailing address
15 APEX DR, HIGHLAND, IL 62249-1282
(618) 441-0482
(618) 441-0482
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070016087
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08220357
BCBS GROUP#
IL
Enumeration date
11/29/2007
Last updated
10/21/2015
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