Individual
MICHAEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-6666
Mailing address
119 S KEYSTONE AVE, SAYRE, PA 18840-1330
(717) 562-9597
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
OT020716
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/20/2021
Last updated
08/10/2021
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