Individual
MICHAEL C. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 E 38TH PL UNIT 1, CHICAGO, IL 60653-1969
(773) 373-0938
Mailing address
PO BOX 16204, CHICAGO, IL 60616-0204
(773) 373-0938
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
MW21240499P
IL
Other
Enumeration date
10/16/2007
Last updated
10/16/2007
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