Organization
ISAIAH WILSON MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISAIAH WILSON MD (CEO)
(517) 862-2565
Entity
Organization
Contact information
Practice address
1200 W ALBANY ST, BROKEN ARROW, OK 74012-8146
(918) 744-2338
Mailing address
PO BOX 1383, JENKS, OK 74037-1383
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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