Individual
MICHAEL R WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3433 S LAFOUNTAIN ST, KOKOMO, IN 46902-3801
(765) 453-3777
(765) 453-6577
Mailing address
3433 S LAFOUNTAIN ST, KOKOMO, IN 46902-3801
(765) 453-3777
(765) 453-6577
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01046415A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200126150
—
IN
Enumeration date
03/29/2006
Last updated
01/25/2011
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